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OBSTETRICAL  NURSE. 


SECOND  EDITION.  REVISED  AND  REWRITTEN 


OBSTETRICAL  NURSING 


FOR 


NURSES  AND  STUDENTS 


BY 


HENRY  ENOS  TULEY,  A.  B..M.  D. 

Professor  of  Obstetrics,  Medical  Department  University  of  Louisville;  Visiting 
Obstetrician  and  Lecturer  on  Obstetrics  to  Training  School   for  Nurses, 
John  N.  Norton  Memorial  Infirmary  and  the  Louisville  City  Hos- 
pital;   Member   Sloane   Maternity  Hospital  Alumni;   Ex-Sec- 
retary and  Chairman  Section  on  Diseases  of   Children, 
American  Medical  Association;    Secretary  Missis- 
sippi Valley  Medical  Association,  etc. 


WITH  73  ILLUSTRATIONS 


LOUISVILLE,  KENTUCKY 

JOHN  P.  MORTON  &  COMPANY 

Incorporated 

1910 


Copyright,  1902, 

By  G.  P.  Englehard  &  Co. 

Copyright  transferred  to  Henry  Enos  Tuley  December  4,  1908, 

Book  38,  Page  5067. 

Copyright,  1910, 
By  Henry  Enos  Tuley,  M.  D. 


To  the  Memory  of  the  late 

ERVIN  ALDEN  TUCKER,  M.  D. 

of  New  York  City, 

Whose  Brilliant  Career  as  an  Obstetrician  was  so  Untimely  Ended, 

this  Book  is  Dedicated, 


PREFACE  TO  THE  SECOND  EDITION 


THE  first  edition,  of  this  little  book  was  published 
in  1902,  in  response  to  the  demand  for  an 
outline  of  the  subjects  covered  in  a  series  of 
lectures  delivered  before  the  training  schools 
for  nurses  of  the  John  N.  Norton  Memorial  Infirmary 
and  of  the  Louisville  City  Hospital.  Owing  to  the 
fact  that  the  publishers  of  the  first  edition  have  dis- 
continued the  publication  of  books,  and  the  original 
plates  were  destroyed,  it  became  necessary  to  re-set  the 
type,  and  advantage  was  taken  of  this  necessity  to  com- 
pletely revise  it  and  to  re-write  a  large  portion  of  it. 
Unfortunately  obstetrics  seems  to  have  no  attrac- 
tion for  the  average  nurse,  and  comparatively  few 
graduates  are  willing  to  include  this  class  of  cases  in 
their  practice,  hence  there  has  been  an  endeavor  to 
make  the  text  of  this  book  as  attractive  as  possible, 
and  to  arouse  the  interest  of  the  pupil  nurse,  as  well 
as  the  graduate,  in  this  important  subject.  The  needs 
of  the  nurse  in  training  have  been  the  first  considera- 
tion, however,  and  only  such  knowledge  as  was  thought 
to  be  absolutely  necessary  for  her  intelligently  to  prac- 
tice obstetrical  nursing  has  been  included.  Much  has 
been  written  in  regard  to  the  over-training  of  the 
trained  nurse,  and  of  her  usurping  the  prerogatives  of 
the  physician.     No  thought  of  this  has  been  allowed  to 


vi  Preface 

enter  into  the  preparation  of  these  pages.  What  is 
given  should  be  known  by  the  nurse,  to  enable  her  to 
intelligently  assist  the  physician  in  the  preparations  for 
labor  and  the  details  of  that  trying  time.  A  busy 
doctor  has  no  time  to  go  into  the  details  of  the  prepara- 
tion of  the  layette  or  the  supplies  and  necessities  for 
the  delivery  room,  and  a  nurse  should  be  able  to  attend 
to  all  of  these. 

The  student  in  medicine  will  find  the  book  of  some 
assistance  to  him  as  a  guide  to  further  study  in  more 
elaborate  works. 

New  illustrations  have  been  added,  and  many  of  the 
old  retained. 

We  are  indebted  to  W.  B.  Saunders  &  Co.  for  per- 
mission to  reproduce  several  cuts  from  their  publica- 
tions, and  for  the  terms  included  in  the  glossary ;  and 
to  Miss  Alice  Lee  Ford  for  valuable  assistance  in  the 
preparation  of  the  manuscript  and  the  revision  of  the 
proof-sheets.  Our  thanks  are  due  to  the  publishers  for 
their  courtesies  in  the  publication. 

Henry  Enos  Tulev. 
February  15,  1910. 


CONTENTS 


CHAPTER  I. 

Anatomy  of  the  Female  Generative  Organs. 

The  Bony  Pelvis;  the  Joints;  Diameters;  Deformities; 
Mons  Veneris;  Labia;  Nymphae;  Clitoris;  Vestibule; 
Meatus;  Hymen;  Perineum;  Breasts;  Vagina;  Uterus; 
Fallopian  Tubes;  Ovaries;  Ligaments;  Rectum;  Peri- 
toneum        1 

CHAPTER  II. 

Physiology  of  the  Reproductive  Organs. 

Menstruation;  Ovulation;  Impregnation;  Embryology; 
Membranes;  Lochia;  Amnion;  Chorion;  Placenta; 
Corel;   Multiple  Pregnancy 16 

CHAPTER  III. 

Pregnancy. 

Signs  of  Pregnancy;  Fetal  Heart;  Ballottement;-  Presump- 
tive Signs;  Menses;  Vagina;  Abdomen;  Quickening; 
Souffle;  Morning  Sickness;  Heartburn;  Salivation; 
Cravings;  Stria?;  Breasts;  Colostrum;  Duration  of 
Pregnancy;  Care  of  Pregnancy;  Diet;  Teeth;  Exercise; 
Clothing;  Varicose  Veins;  Bowels;  Kidneys;  Rest; 
Mental     Condition;     Maternal     Impressions;     Care     of 


Nipples 


CHAPTER  IV. 
Labor. 

Labor;  Pains;  Stages  of  Labor;  Length;  Presentation; 
Attitude;  Position;  Preparation  for  Labor;  the  Nurse; 
Qualifications;  Uniform;  Supplies;  the  Room;  the  Bed; 
the  Patient;  the  Examination;  the  Layette;  Clothes; 
the  Basket;  Care  of  Napkins;  the  Nursery;  Conduct  of 
Labor;  First  Stage;  Second  Stage;  Tying  the  Cord; 
Caul;    Third   Stage 44 


viii  Contents 

CHAPTER  V. 

The  Fuerpekitjm. 

The  Nurse's  Duties;  Breasts  and  Nipples;  Galactagogues; 
Diet;  Dietary;  Bowels;  Bladder;  Catheterization;  the 
Vulva;  Vaginal  Injections;  Intra-uterine  Injection; 
Bedside  Notes;  Rest;  Duration  of  the  Lying-in;  After- 
pains     72 

CHAPTER  VI. 

The  Child. 

The  Head;  Fetal  Circulation;  Eyes;  Umbilical  Cord; 
Umbilicus;  Binder;  Bathing;  the  Bowels;  Urine; 
Weighing;  Sleep;  Cry;  Respiration;  Artificial  Respira- 
tion; the  Pulse;  the  Temperature;  the  Mouth;  Bednars' 
Aphthae;  Teeth;  Premature  Children;  Abnormal  Con- 
ditions in  Infancy;  Deformities;  Breasts;  Foreskin; 
Caput;  Cephalhematoma;  Jaundice;  Sudamina;  Colic; 
Stools;  Cyanosis;  Menstruation;  Hemorrhages;  Granu- 
lating Umbilicus;  Umbilical  Hernia;  Atelectasis; 
Sepsis;  Injuries  to  the  Newborn;  Tetanus 90 

CHAPTER  VII. 

Infant  Feeding. 

Maternal  Nursing;  Examination  of  Breast  Milk;  Duration 
of  Nursing  Period;  Wet-nurse;  Artificial  Feeding; 
Milk  Modification;  Cow's  Milk;  Quantity  of  Feedings; 
Care  of  Bottles  and  Nipples;  Water;  Sterilization  and 
Pasteurization;  Effect  of  Heat;  Artificial  Foods; 
Garage;   Rectal  Feeding L29 

CHAPTER  VIII. 

Operative  Oustetrics. 

Preparation  of  Room,  of  Bed,  of  Patient,  of  Instruments; 
Anesthesia;  Forceps;  Version;  Symphysiotomj';  Pubi- 
otomy;  Caesarian  Section;  Craniotomy;  Perineorrhaphy; 
Transfusion;  Enteroclvsis;  Vaginal  and  Uterine 
Tampon;  the  Douche;  H}rpodermoclysis;  Induction  of 
Premature  Labor 143 


Contents  ix 

CHAPTER  IX. 

Obstetric  Complications. 

Complications  of  Pregnancy;  Nausea  and  Vomiting; 
Eclampsia;  Varicose  Veins;  Pruritus;  Hemorrhages; 
Placenta  Previa;  Extra-uterine  Pregnancy;  Complica- 
tions of  Labor;  Breech  Presentation;  Postpartum 
Hemorrhage;  Complications  of  the  Puerperium;  Puer- 
peral Infection;  After-pains;  Phlegmasia  Alba  Dolens; 
Bladder;  Cystitis;  Pyelitis;  Constipation;  Mastitis; 
Temperature;     Puerperal     Mania 163 

CHAPTER  X. 

Advice  to  Expectant  Mo  i  hers. 

Necessity  for  Advice;  Corsets;  Clothing;  Abdominal  Sup- 
porter; Exercise;  Nursing;  Kidneys;  Unusual  Symp- 
toms; Bathing;  Diet;  Teeth;  Nurse;  Lying-in  Room; 
Obstetrical  Outfit;  Labor  Pains;  Preparation  of  Patient 
for    Labor;    Bed -     -  186 

APPENDIX. 

Solutions;      Sterilization;      Washing     Flannels;      Antiseptic 

Solutions         -------- 195 

Glossary     ------------------  £03 

Index       -         ----------- 239 


Obstetrical  Nursing 


for 


Nurses  and  Students 


CHAPTER  I. 

Anatomy  of  the  Female  Generative  Organs. 

THE  BONY  PELVIS. 

BECAUSE  of  the  likeness  of  the  pelvis  to  a 
basin,  the  name  "pelvis"  was  given  it.  The 
pelvis  is  composed  of  four  bones,  the  two  ossa 
iunominata,  sacrum,  and  coccyx.  The  os 
innominatum  in  infancy  is  composed  of  three  bones, 
which  in  adult  life  become  closely  united,  forming  the 
one  innominate  bone.  These  bones  are  the  ilium,  the 
wide,  flaring  top  of  the  pelvis ;  the  ischium,  upon  whose 
tuberosity  the  body  rests  in  the  sitting  position,  and 
the  pubic  bone,  the  front  of  the  pelvis. 

The  Joints. — The  junction  of  the  pubic  bones  is 
called  the  symphysis  pubis;  the  junction  of  the  ilium 
and  sacrum,  the  sacro-iliae  sychondrosis,  or  sacro-iliac 
joint ;  the  junction  of  the  sacrum  and  coccyx,  the  sacro- 


2  Obstetrical  Nursing 

coccygeal  joint,  and  that  of  the  last  lumbar  vertebra 
and  sacrum  the  sacro-vertebral  joint.  The  sacro- 
coccygeal  joint   is   movable   in   pregnancy   and   labor. 


FIG.  I.      FEMALE  PELVIS,  SHOWING  SUPERIOR  STRAIT. 

allowing  the  tip  of  the  coccyx  to  be  pressed  backward 
as  the  head  is  born,  thereby  increasing  the  antero- 
posterior diameter  as  much  as  one-fourth  to  half  an 
inch.  Should  a  fracture  of  the  coccyx  occur  and  an 
ankylosis  follow  with  its  tip  pointed  forward,  a  severe 


Obstetrical  Nursing  3 

deformity  of  the  pelvis  would  result,  causing  a  difficult 
birth  because  of  the  shortened  distance  between  the 
coccyx  and  pubes.  This  joint  becomes  ankylosed  as  the 
woman  grows  older,  and  because  of  this  the  birth  of 
the  first  child  is  apt  to  be  more  difficult  after  thirty 
years  of  age. 


FIG.  2.      FEMALE  PELVIS,  SHOWING  OUTLET. 

Upon  the  upper  articulating  surface  of  the  sacrum 
rests  the  spinal  column,  and  immediately  below  and  on 
its  anterior  surface  is  located  the  promontory  of  the 
sacrum.  From  this  point,  the  promontory  of  the  sacrum 
to  the  posterior  surface  of  the  symphysis  pubis,  is 
measured  the  anteroposterior  or  conjugate  diameter 
of  the  inlet  of  the  pelvis. 

On  the  inner  surface  of  the  pelvis,  running  around 
at  the  base  of  the  ilium,  beginning  at  the  promontory 
of  the  sacrum  and  ending  with  the  top  of  the  symphysis. 


4  Obstetrical  Nursing 

can  be  seen  a  distinct  ridge  or  line,  which  is  called  the 
ilio-pectineal  line.  This  line  divides  the  pelvis  into  two 
parts,  all  that  above  being  the  false  pelvis,  that  below 
the  true  or  bony  pelvis.  The  latter  is  also  referred  to 
as  the  cavity  of  the  pelvis.  That  part  of  the  pelvis 
above  the  ilio-pectineal  line  is  called  the  brim,  the 
superior  strait,  or  the  inlet;  that  below  this  line  the 
true  or  bony  pelvis,  the  inferior  strait,  or  the  outlet. 

The  dried  pelvis  of  the  skeleton  is  called  the  static 
pelvis,  and  the  pelvis  of  the  living,  child-bearing  woman 
the  dynamic  pelvis. 

Diameters. — The  distance  between  two  given  and 
fixed  points  of  the  pelvis  is  called  a  diameter,  and  these 
are  generally  measured  at  the  brin  and  at  the  outlet. 
There  are  four  diameters  at  the  brim,  or  inlet,  and  a  like 
number  at  the  outlet.  They  are  the  antero-posterior  or 
conjugate  diameter J  the  transverse,  the  right  oblique, 
and  the  left  oblique.  Practically  the  only  diameter  at 
the  outlet  with  which  we  are  concerned  is  the  antero- 
posterior or  conjugate. 

By  means  of  the  pelvimeter  (Fig.  3)  these  external 
measurements  can  be  easily  taken. 

The  antero-posterior  diameter  ol  the  inlet  is  measured 
from  the  promontory  of  the  sacrum  to  the  middle  of  the 
posterior  surface  of  the  symphysis  pubis ;  the  transverse 
diameter  between  the  widest  points  of  the  pelvis;  the 
right  oblique  from  the  right  sacro-iliac  synchondrosis 
(sacro-iliac  joint)  to  the  pectineal  eminence  of  the  op- 
posite side;  the  left  oblique  from  the  left  sacro-iliac 
synchondrosis  to  the  opposite  pectineal  eminence.  Tt 
must  be  borne  in  mind  that  the  oblique  diameters  take 
their  names  from  their  starting  point  behind.  In  the 
dynamic  pelvis  the  transverse  diameter  at  the  inlet  is 
the  longest,  but  when  the  true  pelvis  is  reached,  because 


Obstetrical  Nursing 


of  the  room  taken  up  by  the  muscles  located  on  its  sides, 
the  oblique  diameters  are  longer.  At  the  outlet  the 
antero-posterior  or  conjugate  diameter  is  the  longest, 
because  the  coccyx  is  displaced  backward  as  the  head 
is  born  through  the  outlet. 


FIG.  3.      PELVIMETER. 

It  is  essential  in  the  study  of  obstetrics  to  remem- 
ber that  Nature  provides  that  the  shortest  diameter  of 
the  child's  head  shall  occupy  the  longest  diameter  of  the 
pelvis,  and  this  substituting  of  diameters  and  rotating 
of  the  head  into  longer  ones  is  called  the  mechanism  of 
labor.  The  slightest  deviation  will  oftentimes  cause 
serious  trouble,  a  complicated,  abnormal  labor,  or 
dystocia.     A  normal  labor  is  called  eutocia. 


6  Obstetrical  Nursing 

If  a  piece  of  paper  is  cut  so  as  to  float  on  the  surface 
of  water  in  a  basin  and  to  closely  touch  all  edges  of  the 
basin,  we  have  the  plane  of  this  surface.  If  in  like  man- 
ner we  fit  a  card  to  the  inlet  of  the  pelvis,  touching  all 


FIG.  4.      C — F=CURVE   OF  CARUS  (A.  T.  B.  OBSTETRICS). 

its  sides,  we  have  the  plane  of  the  inlet,  and  these  im- 
aginary planes  can  be  placed  at  different  levels  through- 
out the  cavity  of  the  pelvis.  If  a  perpendicular  line  is 
Lei  fall  upon  each  of  these  imaginary  planes  of  the  pelvis, 
the  result  is  a  curved  line,  the  course  the  child  must  take 
as  it  is  born,  and  is  called  the  curve  of  Carus. 

The  pelvis  of  the  female  differs  from  that  of  the  male 
in  several  important  points ;  it  is  shallower  and  roomier, 


Obstetrical  Nursing  1 

the   bones   are   lighter,   and   the   arch   of   the   pubis   is 
shorter  and  wider. 

Deformities. — Owing  to  bony  disease  in  early  life, 
the  pelvis  may  be  misshapen  or  flattened  sufficiently  to 
interfere  with  the  passage  of  the  child,  or  even  to  ne- 
cessitate its  delivery  by  Csesarean  section.  The  most 
frequent  pelvic  deformity  is  the  fiat  pelvis,  in  which  the 
antero-posterior  or  true  conjugate  diameter  is  quite 
markedly  shortened.  Any  marked  deviation  in  the 
length  of  the  diameters  revealed  by  external  pelvimetry 
should  cause  a  shortening  of  the  internal  measurements 
to  be  suspected  at  once. 

THE  GENERATIVE  ORGANS. 

The  female  generative  organs  are  divided  into  two 
groups,  the  external  and  internal.  The  external  organs 
are  classed  under  one  generic  term,  the  vulva.  The  ex- 
ternal organs  are  the  mons  veneris,  labia  majora,  labia 
minora,  clitoris,  vestibule,  meatus  urinarius,  glands  of 
Bartholin,  hymen,  and  perineum. 

Mons  Veneris. — Beginning  at  the  top  is  the  mons 
veneris.  This  is  an  eminence  composed  of  fatty  tissue, 
situated  on  top  of  the  symphysis  pubis,  and  covered  with 
hair.  It  is  of  no  special  obstetrical  significance  except 
as  a  landmark. 

Labia. — From  the  mons  veneris  running  backward 
are  the  labia  majora  and  labia  minora.  The  labia  ma- 
jora are  external  to  the  labia  minora,  larger,  and  ap- 
proximate on  their  inner  surfaces.  They  are  covered 
with  skin  and  hair  externally,  and  with  a  modified 
smooth  skin  on  the  approximating  surfaces.  In  the 
skin  covering  the  inner  surfaces  are  many  minute  seba- 
ceous glands,  which  secrete  a  mucus-like  material  which 
aids  in  lubricating  the  parts  during  labor.     These  labia 


8  Obstetrical  Nursing 

coalesce  anteriorly  in  the  mons  veneris,  and  at  the  poste- 
rior junction   form   the   posterior   commissure. 

At  the  lower  junction  of  the  labia  majora  and  labia 
minora  on  each  side  are  located  the  glands  of  Bartho- 
lin. They  are  of  the  compound  racemose  variety,  and 
secrete  much  mucus  at  the  time  of  labor.  If  infected 
with  pus-producing  organisms  an  abscess  may  form  in 
them. 

Nymphae. — The  labia  minora,  or  nymphae,  normally 
lie  inside  the  labia  majora,  though  they  may  become 
much  elongated  and  prove  very  uncomfortable  in  walk- 
ing. Their  outer  coat  is  mucous  membrane,  which  is 
covered  with  pavement  epithelium.  Imbedded  in  the 
mucous  membrane  are  sebaceous  glands. 

Clitoris. — Anteriorly  where  the  labia  minora  coa- 
lesce they  embrace  the  clitoris,  a  very  sensitive  organ 
located  below  the  junction  of  the  labia  majora.  The 
upper  folds  of  the  labia  minora  form  the  prepuce  of  the 
clitoris,  the  lower  folds  the  frenum. 

Vestibule. — Below  the  clitoris  and  between  this  organ 
and  the  vagina  is  a  triangular,  smooth  area,  covered 
with  mucous  membrane,  called  the  vestibule,  the  apex 
of  the  triangle  being  at  the  clitoris. 

Meatus. — In  the  middle  of  the  lower  border  of  the 
vestibule  is  the  opening  of  the  urethra,  the  meatus 
urinarius.  This  is  a  little  prominence  and  can  ordina- 
rily be  easily  felt;  but  in  catheterization  after  labor 
it  should  never  be  located  by  touch.  Because  of  the 
swollen  and  congested  state  of  the  vulva  following 
labor  the  meatus  is  displaced  and  not  easily  located. 
Tlie  urethra  is  about  one  and  a  half  inches  long,  the 
size  of  a  small  lead  pencil,  and  leads  from  the  meatus  to 
the  neck  of  the  bladder. 

Hymen. — The  orifice  of  the  vagina  in  the  virgin  is 
partly  covered  with  folds  of  mucous  membrane  from  the 


Obstetrical  Nursing  9 

labia  minora,  called  the  hymen.  The  opening  in  the 
hymen  is  of  several  kinds,  the  annular,  cribriform,  etc. 
The  hymen  is  ruptured  at  the  first  intercourse,  or  by 
violence,  but  after  the  birth  of  the  first  child  there 
result  from  the  pressure  a  number  of  small  prominences 
around  the  orifice  of  the  vagina,  inside  the  labia  minora, 
called  the  caruncula  myrtiformes. 

Perineum. — The  space  between  the  vagina  and  the 
rectum,  behind,  is  the  perineal  space  or  perineum,  and 
the  triangular  mass  of  muscular  and  connective  tissue 
extending  from  the  skin  upward  between  the  vagina 
and  rectum,  the  base  of  the  triangle  at  the  skin,  is  called 
the  perineal  body.  This  body  is  of  great  obstetrical  im- 
portance, as  it  must  be  greatly  stretched  as  the  head 
is  being  born  and  frequently  is  torn  at  this  stage  of 
labor.  It  is  very  essential,  if  possible,  to  preserve  this 
body,  as  it  acts  as  a  support  to  the  pelvic  organs.  If 
it  is  torn  it  should  be  repaired  at  once  by  suturing,  or 
a  secondary  operation,  called  perineorrhaphy,  is  neces- 
sary at  a  later  date.  It  may  be  done  at  once  or  after 
the  expiration  of  several  hours,  when  the  patient  has 
rested  from  her  labor.  It  may  be  torn  very  super- 
ncially,  deep  into  the  muscle,  or  the  tear  may  extend 
through  the  sphincter  muscle  into  the  rectum,  this  con- 
stituting a  complete  tear.  The  tear  may  also  extend  up 
in  the  vagina,  and  no  case  is  complete  without  a  thorough 
investigation  being  made  of  the  perineum  and  vaginal 
walls  after  delivery. 

Breasts. — The  breasts  are  generally  classed  among 
the  external  generative  organs.  They  are  two  in  num- 
ber, situated  on  the  anterior  chest  wall  between  the 
second  and  ninth  ribs.  They  are  compound  racemose 
glands,  composed  of  fifteen  or  twenty  milk  lobes  and  milk 
ducts,  the  latter  ending  at  the  nipples.  The  breasts 
vary  in  size  in  different  individuals,  but  always  enlarge 


10  Obstetrical  Nursing 

as  the  result  of  pregnancy.  After  having  suckled  a  child 
the  breasts  generally  are  flabby,  and  always  are  much 
smaller  when  lactation  is  stopped.  In  the  center  of  the 
breasts  are  the  nipples,  which  are  surrounded  by  a 
darkened  area,  called  the  areola,  dark  in  brunettes  and 
lighter  in  blondes.  The  nipples  contain  erectile  tissue, 
becoming  prominent  when  irritated.  Supernumerary 
breasts  may  be  found  upon  other  parts  of  the  body. 
In  the  areola  are  located  fifteen  or  twenty  glands,  the 
glands  or  tubercles  of  Montgomery,  which  become 
larger  as  pregnancy  advances. 

INTERNAL  GENERATIVE  ORGANS. 

The  internal  generative  organs  are  the  vagina,  the 
uterus,  Fallopian   tubes,  and  ovaries. 

Vagina. — The  vagina  is  a  musculo-membranous  tube 
lying  in  the  pelvic  canal,  between  the  bladder  in  front 
and  the  rectum  behind.  Its  orifice  is  partly  closed  by 
the  hymen  in  the  virgin,  and  embraces  the  vaginal  por- 
tion of  the  uterus,  the  cervix,  at  its  upper  extremity. 
It  has  two  coats,  the  mucous  and  muscular.  The  mucous 
membrane  is  thrown  into  folds,  which  encircle  the  va- 
gina, and  is  covered  with  squamous,  or  pavement,  epithe- 
lium. Its  anterior  wall,  in  contact  with  the  bladder,  is 
shorter  than  the  posterior,  which  is  in  contact  with  the 
rectum  in  its  lower  portion.  The  anterior  and  posterior 
walls  of  the  vagina  are  in  contact.  If  .labor  lasts  a  long 
time  the  pressure  of  the  head  resting  in  the  pelvis  may 
cause  a  death  of  the  soft  tissue  and  an  opening  into  the 
bladder  follows,  through  which  urine  flows  into  the  va- 
gina. This  is  called  a  vesico-vaginal  fistula.  If  an  open- 
ing results  between  the  vagina  and  the  rectum  it  is 
called  a  recto-vaginal  fistula.  The  posterior  wall  of  the 
vagina  in  its  upper  third  is  in  contact  with  the  peri  to- 


Obstetrical  Nursing 


11 


Clavicfr* 


5econ<fJ?ib 


.first  Rib 


H/f> 


FIG.  5.      FEMALE    BREAST  (A.  T.  B.  OBSTETRICS) 


12  Obstetrical  Nursing 

neum,  which  is  reflected  down  from  the  posterior  wall 
of  the  uterus.  The  fold  of  peritoneum  from  this  point 
is  reflected  on  to  the  rectum,  forming  a  pouch,  which  is 
called  Douglas'  cul-de-sac,  or  pouch.  A  collection  of 
pus  in  the  peritoneal  cavity  at  this  point  can  be  drained 
by  an  incision  through  the  vaginal  wall.  The  middle 
third  of  the  vagina  is  in  contact  with  the  rectum,  and 
the  lower  third  with  the  perineal  body. 

Uterus. — The  uterus,  or  womb,  is  a  pear-shaped  or- 
gan, in  which  the  child  develops  after  impregnation  of 
the  ovum.  It  is  divided  into  three  parts,  the  fundus  or 
top,  the  body,  and  the  neck  or  cervix.  It  has  three  coats, 
the  mucous,  lined  with  columnar  epithelium;  muscular, 
its  fibers  arranged  in  three  layers,  and  the  peritoneum. 
It  has  three  openings,  one  into  the  cervix  and  one  in 
each  Fallopian  tube,  those  into  the  tubes  being  at  the 
upper  corners  of  the  uterus,  the  right  and  left  cornu. 

The  muscular  layer  of  the  uterus  has  three  layers  of 
fibers,  the  circular  layer  being  the  thickest.  The  outer 
coat  of  the  womb  is  peritoneum,  covering  its  anterior 
surface  and  reflected  thence  on  to  the  bladder,  covering 
the  posterior  surface  throughout  its  extent  down  to  the 
middle  third  of  the  vagina,  from  there  being  reflected 
on  to  the  rectum,  this  fold  being  Douglas'  cul-de-sac, 
above  referred  to.  The  two  layers  of  peritoneum  leav- 
ing the  uterus  on  the  sides  unite  and  form  the  broad 
ligaments ;  these  are  attached  to  the  ilium  on  each  side 
and  serve  as  supports  to  the  womb.  In  the  folds  of  the 
broad  ligaments  rest  the  Fallopian  tubes  and  ovaries, 
one  of  each  on  each  side. 

The  cervix  is  about  two  inches  in  length,  the  upper 
pari  of  it  being  encircled  by  the  vault  of  the  vagina, 
leaving  the  major  portion  of  it  in  the  vagina,  and  is 
called  the   vaginal   portion  of  the   cervix.     It   has   two 


Obstetrical  Nursing 


13 


openings,  with  a  canal  between,  the  openings  being  called 
the  external  and  internal  os. 


DOUGLAS.. 
Cul-de-sac 


OVARV 
FALLOPIAN 
TUBE 


UTERU5 
CERVIX 

.BLADDER- 
.RECTUM 

.  VAGINA 

URETHRA 
PERINEUM 


FIG.  6.   FEMALE  ORGANS  OF  GENERATION. 


Fallopian  Tubes.  The  Fallopian  tubes  are  about 
six  inches  in  length  and  about  one-sixth  of  an  inch  in 
diameter.  They  have  three  coats,  mucous,  muscular, 
and   peritoneal   or   serous.     The   mucous   membrane   is 


14  Obstetrical  Nursing 

lined  with  columnar  ciliated  epithelium,  and  it  is  thrown 
into  many  fine  folds,  called  plications. 

The  free  end  of  the  tube  has  a  number  of  finger-like 
projections,  called  fimbriae,  the  end  being  called  the 
fimbriated  extremitj^.  One  of  the  fimbriae  is  attached 
to  the  ovary;  the  others  are  free,  and  grasp  the  ovary 
to  catch  the  ovum,  or  egg,  when  it  is  discharged  monthly. 

Ovaries. — The  ovaries  are  almond-shaped  organs, 
lying  in  the  folds  of  the  broad  ligaments  at  the  side  of 
the  uterus,  and  contain  the  ova  or  eggs.  These  are  con- 
tained mostly  in  the  outer  zone  of  the  ovary,  or  cortical 
portion,  125,000  to  150,000  in  each  ovary.  The  inner 
portion  of  the  ovary,  containing  the  blood-vessels,  is 
the  medullary  portion.  The  fully  developed  ovum  is 
1-120  inch  in  diameter,  and  its  home  in  the  ovarj^  is  the 
Graafian  follicle. 

Ligaments. — The  uterus  is  supported  by  the  round 
ligaments  in  front,  which  are  attached  in  the  mons 
veneris  and  prevent  backward  displacements  of  the 
uterus ;  the  broad  ligaments,  folds  of  peritoneum,  ex- 
tending to  the  ilia  at  the  sides;  the  utero-sacral  liga- 
ments, which  run  from  the  uterus  to  the  sacrum.  The 
uterus  lies  in  the  pelvic  cavity,  the  fundus  turned  toward 
the  symphysis  pubis  and  resting  on  the  bladder.  This 
is  the  normal  position  of  anteversion;  if  the  fundus  is 
turned  backward  in  the  hollow  of  the  sacrum  it  is  a 
retroversion.  The  canal  leading  from  the  bladder  with 
an  external  opening  is  the  urethra.  It  is  about  the 
size  of  a  lead  pencil,  one  and  a  half  inches  in  length,  the 
external  opening  being  the  meatus  urinarius. 

Rectum. — The  rectum  is  the  end  of  the  colon,  and 
lies  in  the  hollow  of  the  sacrum  on  the  left  side,  the 
uterus  and  vagina  lying  in  front.  The  rectum  is  con- 
tinuous with  the  sigmoid  flexure  above  and  ends  in  the 


Obstetrical  Nursing  15 

anus  below.  The  internal  and  external  sphincter  ani 
muscles  close  the  anal  canal. 

The  rectum  should  give  no  trouble  in  labor,  and  gen- 
erally does  not,  except  just  as  the  child  is  born.  As  a 
result  of  the  stretching  and  pulling  forward  of  the  peri- 
neum the  mucous  membrane  of  the  rectum  protrudes, 
is  caught  by  the  external  sphincter  muscle,  and  if 
squeezed  long  enough  the  blood-vessels  will  become  en- 
larged, forming  hemorrhoids.  This  can  generally  be 
avoided  if  the  prolapsed  mucous  membrane  is  anointed 
well  with  vaseline  after  the  child  is  born,  and  with  the 
palmar  surface  of  two  or  three  fingers  pressed  gently 
back  inside  the  sphincter  muscles.  The  employment  of 
small  enemas  each  morning  before  evacuation  will  pre- 
vent straining  and  prolapsus  again.  The  movement  of 
the  bowels  on  a  bed-pan  in  the  recumbent  position  pre- 
vents much  straining. 

Peritoneum. — The  peritoneum  is  the  serous  mem- 
brane covering  the  abdominal  and  pelvic  organs  and 
lining  the  abdominal  walls.  A  fold  of  peritoneum  com- 
ing down  from  the  anterior  abdominal  wall  is  reflected 
over  the  anterior  wall  of  the  bladder,  thence  over  its 
summit  and  on  to  the  anterior  walls  of  the 
uterus  from  the  posterior  surface  of  the  blad- 
der. The  folds  of  the  peritoneum  coming  together 
at  the  sides  of  the  uterus  constitute  the  broad 
ligaments.  From  the  posterior  wall  of  the  uterus 
the  peritoneum  extends  downward,  covering  the  upper 
third  of  the  posterior  wall  of  the  vagina,  and  is  then 
reflected  on  to  the  rectum.  This  fold  of  peritoneum  is 
called  Douglas'  pouch  or  cul-de-sac,  and  is  of  importance 
from  a  surgical  standpoint,  as  pelvic  secretions  may  col- 
lect here  and  be  drained  by  an  incision  through  the 
posterior  upper  third  of  the  vagina. 


CHAPTER  II. 

Physiology  of  the  Reproductive  Organs. 

Menstruation. — The  mucous  membrane  of  the  uterus 
is  lined  with  columnar  ciliated  epithelium,  and  each 
month  this  is  shed  during  menstruation,  there  being  four 
periods  to  this  function — the  stage  of  congestion,  during 
which  the  membrane  is  swollen  and  thickened,  the  vessels 
being  enlarged;  the  stage  of  destruction,  in  which  the 
membrane  is  shed  down  to  the  muscular  layer,  along  with 
blood  from  the  dilated  and  ruptured  vessels;  the  stage 
of  repair,  during  which  the  mucous  membrane  is  formed; 
and  the  stage  of  quiescence  and  rest,  before  the  next 
period  is  due.  This  function  of  menstruation  recurs 
every  twenty-eight  days,  though  it  may  recur  with 
greater  frequencj^,  the  stage  of  destruction  and  flow 
lasting  from  three  to  seven  days.  Menstruation  gener- 
ally begins  about  the  fourteenth  year,  recurring  once 
a  month  unless  pregnancy  exists,  this  period  in  a  girl's 
life  being  called  puberty.  In  some  women  even  after 
impregnation  a  monthly  flow  of  blood  occurs  with  regu- 
larity throughout  pregnancy,  or  during  the  first  few 
months,  though  they  are  quite  rare.  The  cessation  of 
the  menstrual  function  later  in  life  is  called  the  me)i<>- 
paust . 

Ovulation. — This  is  the  periodical  discharge  of  the 
mature  ovum  from  the  ovary.  Just  how  often  an  ovum 
is  thrown  off  is  not  known.  While  not  an  accompani- 
ment of  menstruation,  it  may  be  coincident  with  that 
t'u  net  ion.  The  home  of  the  ovum  is  the  Graafian  fol- 
licle and  when  it  ruptures  the  Qgg  is  discharged  on  the 
surface  of  the  ovary  and  is  at  once  grasped  by  the 
fimbriated  extremity  of  the  Fallopian  tube.  If  this  egg 
is  impregnated,  the  cavity  of  the  Graafian  follicle,  which 


Obstetrical  Nursing  17 

after  the  escape  of  its  contents  is  filled  with  blood,  con- 
tinues to  enlarge  until  about  the  seventh  month  of 
gestation.  This  clot  turns  yellow,  forming  the  yellow 
body,  or  corpus  luteum,  of  pregnancy.  The  corpus  lu- 
teum  of  ovulation  forms  simply  a  scar  on  the  surface  of 
the  ovary. 

Impregnation  (fertilization,  fecundation,  concep- 
tion).— This  is  the  junction  of  the  male  spermatozoon 
and  the  female  ovum,  and  generally  takes  place  in  the 
outer  third  of  the  Fallopian  tube ;  from  thence,  with  the 
aid  of  the  motion  of  the  tube  itself,  and  the  cilia  of  the 
columnar  epithelium,  the  fecundated  ovum  falls  into  the 
uterus,  where  it  is  held  by  the  folds  of  the  mucous  mem- 
brane comprising  the  decidua  reflexa.  It  may  lodge  in 
the  tube  and  grow  there,  constituting  a  tubal  pregnancy, 
or  ectopic  gestation.  The  tube  can  only  be  stretched  to 
the  size  the  ovum  obtains  at  about  six  weeks,  when  it 
ruptures,  resulting  in  hemorrhage,  and  if  in  the  abdom- 
inal cavity,  unless  an  operation  is  performed  and  the 
bleeding  tube  tied  off,  the  patient  will  probably  die. 

The  spermatozoon,  the  male  element,  is  shaped  like 
a  tadpole,  with  head,  neck,  and  tail,  and  of  the  many 
present  and  capable  of  impregnating  an  ovum,  only  one 
penetrates  it.  As  soon  as  the  head  of  the  spermatozoon, 
the  only  portion  which  enters  the  ovum,  has  penetrated 
its  wall,  this  cell  divides  into  two  equal  portions,  each 
containing  half  the  yolk.  These  two  subdivide  into  four, 
the  four  into  eight,  and  so  on  indefinitely  until  the 
ovum  is  full  of  many  smaller  cells.  This  process  is 
called  segmentation.  The  ovum  at  this  stage  is  called 
the  morula,  or  mulberry  body.  These  cells  shortly  be- 
gin to  bank  themselves  into  a  mass  at  one  side  of  the 
ovum,  leaving  a  space  opposite.  This  is  called  the 
stage  of  the  blast ula,  or  blastodermic  vesicle. 


18  Obstetrical  Nursing 

The  cells  now  arrange  themselves  in  layers,  at  first 
two,  then  these  two  form  the  third;  from  these  three 
layers  all  of  the  tissues  of  the  body  are  made.  From 
the  outer  layer,  ectoderm,  are  formed  the  nervous  system, 
skin  and  its  appendages — the  hair,  nails,  etc. — the 
chorion,  amnion,  and  placenta;  from  the  middle  layer, 
mesoderm,  the  bony  framework  and  muscles  of  the  body, 
the  blood,  lymphatic  system,  and  peritoneum ;  and  from 
the  inner  layer,  entoderm,  the  intestines  and  epithelial 
lining  of  the  organs  of  the  thoracic  and  abdominal 
cavities. 

At  the  end  of  four  weeks  the  ovum  is  the  mulberry- 
shaped  body  described  above,  but  during  the  next  four 
weeks  the  ovum,  now  called  the  embryo,  assumes  shape, 
with  recognizable  head  and  body.  At  the  end  of  the 
third  month  it  takes  the  name  of  fetus. 

At  the  end  of  two  weeks  the  ovum  is  2  mm.  in 
length ;  at  four  weeks,  8  mm. ;  at  eight  weeks,  25  mm. ; 
at  five  months,  200  mm. ;  at  seven  months,  370  mm. ; 
at  nine  months,  500  mm. 

At  the  end  of  the  third  month  the  fetus  weighs 
about  four  ounces;  the  head  is  the  largest  part  of  the 
body;  the  extremities  are  formed  and  the  fingers  pres- 
ent, the  sex  can  be  determined,  and  the  placenta  is 
formed. 

At  the  end  of  the  sixth  month  the  fetus  weighs  about 
a  pound,  and  at  the  end  of  the  seventh  month  it  weighs 
about  three  and  one-half  pounds.  The  hair  of  the  scalp, 
the  eyebrows  and  lids  are  present,  the  vernix  caseosa  is 
present,  and  from  this  time,  if  born  prematurely,  the 
child  is  viable,  or  able  to  maintain  an  existence  without 
the  mother's  nourishment. 


Obstetrical  Nursing  19 


EMBRYOLOGY. 

The  child,  is  generally  spoken  of  as  the  embryo  until 
about  the  third  month,  when  the  placenta  is  formed, 
and  as  the  fetus  after  this  period. 

Membranes. — There  are  two  sets  of  membranes 
formed  during  pregnancy  which  play  an  important  part 
in  gestation;  one  set,  the  amnion  and  the  chorion,  is  de- 
rived from  the  embryonic  structure,  the  ovum ;  the  other, 
the  decidual  membranes,  from  the  mother. 

There  are  three  deciduas,  all  formed  from  uterine 
mucous  membrane ;  decidua  vera,  decidua  reflexa,  and 
decidua  serotina.  The  lining  membrane  of  the  uterus, 
which  as  the  result  of  impregnation  is  swollen,  con- 
gested, and  thrown  into  folds,  is  the  decidua  vera,  or 
true  decidua.  When  the  ovum  is  impregnated  it  falls 
into  the  uterus  from  the  Fallopian  tube,  where  impreg- 
nation is  supposed  to  take  place,  into  one  of  these  folds 
of  the  decidua  vera.  Very  soon  these  folds  are  reflected 
up  and  unite  over  the  ovum,  holding  it  in  place.  They 
are  called  the  decidua  reflexa.  At  the  point  where  the 
ovum  lodges  on  the  decidua  vera,  the  placenta  is  formed 
afterward,  and  this  area  is  called  the  decidua  serotina. 

Lochia. — The  decidua  reflexa,  as  the  ovum  grows,  is 
pressed  against  the  decidua  vera,  and  finally  disappears. 
The  decidua  vera  and  serotina  come  away  in  the  form  of 
the  lochia,  after  the  birth  of  the  child.  The  lochia 
during  the  first  two  or  three  days  is  mostly  made  up  of 
pure  blood,  and  is  called  lochia  rubra.  It  is  usually 
necessary  to  change  the  pads  worn  at  this  time  about 
every  two  hours.  During  the  next  week  the  lochia 
becomes  paler  pink  in  color,  and  is  much  less  profuse. 
This  is  the  lochia  cruenta.     During  the  last  of  the  puer- 


20 


Obstetrical  Nursing 


perium  the  discharge  becomes  very  pale  or  colorless, 
and  is  called  lochia  alba.  The  lochia  usually  lasts  from 
three  to  four  \v<j(-ks. 


Beginning  Pfarenta 
C/ivri(rnJrrotu/(rs> 


De^irf/***' 


I  Hit/  Os 


vms  Pent/tn 


Ulertrte 
f///Jr7e- 


If tf 


FIG.  7.      PREGNANT  UTERUS  AT  SEVENTH  WEEK  (a.   T.  B.  OBSTETRICS). 


Obstetrical  Nursing  21 

Amnion. — Very  soon  after  the  ovum  is  impregnated 
the  cells  form  a  membrane,  enclosing  the  embryo  entirely. 
This  is  called  the  amnion;  the  cavity  inside  the  amnion 
is  the  amniotic  cavity,  and  is  filled  with  a  fluid,  the 
liquor  amnii  or  amniotic  fluid,  and  in  this  fluid  the 
embryo  floats.  It  also  serves  the  purpose  of  protecting 
the  embryo  from  jolts  and  jars,  supplies  it  with  some 


FIG.  8.   FETAL  SURFACE  OF  PLACENTA. 

water,  and  later,  at  the  time  of  labor,  the  amnion  acts 
as  a  wedge  or  dilator  to  the  cervix.  When  there  is  a 
very  small  quantity  of  liquor  amnii  the  condition  is 
called  oligohydramnios,  and  when  present  to  an  ex- 
cessive amount  is  called  hydramnios.  When  the  mem- 
branes rupture  and  the  liquor  amnii,  which  is  in  front 
of  the  presenting  part,  escapes  before  the  beginning  of 
labor,  or  very  shortly  after  the  first  pain,  it  is  called 
a  dry  labor. 

Chorion. — The   other   embryonic   membrane   is  the 
chorion,  which  is  an  important  structure,  as  through  it 


22 


Obstetrical  Nursing 


the  embryo  obtains  nourishment  until  the  formation  of 
the  placenta.  Numerous  little  finger-like  projections 
form  on  the  surface  of  the  chorion,  called  villi.  Through 
these  the  nourishment  is  absorbed.  Those  villi  that 
touch  the  decidua  serotina  form  the  placenta,  and  the 
rest  of  the  villi  touching  the  decidua  renexa  disappear. 
Placenta. — The  placenta  is  the  organ  of  respiration 
and  the  source  of  nutrition  for  the  child.    It  grows  upon 


FIG.  9.      MATKRNAL  SURFACE   OF   PLACENTA. 

the  decidua  serotina,  dipping  down  into  depressions  in 
the  uterus.  The  mother's  blood  here  gives  off  oxygen 
and  the  necessary  nourishment  and  takes  on  carbon 
dioxide  from  the  child's  blood,  the  pure  blood  being 
carried  to  the  child  through  the  umbilical  cord.  It  must 
be  remembered  that  there  is  no  admixture  of  maternal 
and  fetal  blood.  This  interchange  of  gases  and  nourish- 
ment for  the  fetus  goes  on  through  a  very  thin  mem- 
brane by  a  process  of  osmosis,  the  two  blood-currents 
not  mixing  at  all. 


Obstetrical  Nursing  23 

The  placenta  is  generally  round  or  oval,  about  twelve 
inches  in  diameter,  about  an  inch  in  thickness,  and 
weighs  about  a  pound.  It  has  two  surfaces,  the  fetal 
and  maternal;  the  fetal  surface  is  smooth  and  covered 
with  amnion,  and  into  it  is  inserted  the  umbilical  cord. 
The  maternal  surface  is  rough  like  raw  beef,  is  divided 
into  many  sections  by  sinuses.  These  sections  are 
cotyledons,  and  fit  into  corresponding  depressions  in 
the  uterus. 

Cord. — The  umbilical  cord,  or  funis,  varies  in  length 
from  fifteen  to  forty  inches,  and  is  attached  generally 
about  the  center  or  to  one  side  of  the  fetal  surface  of  the 
placenta.  It  contains  three  blood-vessels — two  arteries 
and  one  vein.  These  vessels  are  imbedded  in  a  gelati- 
nous substance  called  "Wharton's  jelly,  which  protects 
them  from  pressure.  The  vein  carries  arterial  blood 
from  the  placenta  to  the  child,  the  arteries  carry  venous 
blood  from  the  child  to  the  placenta.  The  cord  con- 
tains no  lymphatics  or  nerves,  hence  there  is  no  pain 
when  the  cord  is  cut. 

When  the  cord  is  inserted  in  the  center  of  the  pla- 
centa it  is  a  central  implantation;  on  the  side,  a  lateral 
implantation;  on  the  edge,  a  battledore  insertion,  and 
when  attached  by  the  blood-vessels,  a  velamentous  in- 
sertion. 

The  cord  may  become  wrapped  around  any  part  of 
the  child — neck,  arms,  body,  or  leg — and  may  become 
tied  into  a  knot.  The  large  dilated  veins  on  the  cord 
are  varicosities. 

Because  of  the  possibility  of  a  hemorrhage  from  the 
cord  occurring  after  it  has  been  tied,  the  cord  should 
be  inspected  frequently  during  the  first  few  hours  after 
birth,  and  retied  if  bleeding  occurs.  The  use  of  a 
rubber  ligature  invariably  prevents  hemorrhage. 


24 


Obstetrical  Nursing 


MULTIPLE  PREGNANCY. 

It  has  already  been  stated  that  but  one  spermatozoon 
gains  entrance  to  an  ovum  to  accomplish  fecundation. 
This  is  true  if  the  ovum  contains  but  one  nucleus  and 
nucleolus.  If  there  are  two  nuclei  and  nucleoli  and  two 
spermatozoa  gain  entrance,  twin  pregnancy  will  result. 
These  twins  will  be  of  the  same  sex,  and  there  will  be 
but  one  placenta  with  two  umbilical  cords.  If  two  ova 
with  single  nuclei  are  discharged,  one  from  each  ovary, 
and  both  are  fecundated,  twin  pregnancy  will  result; 
the  children  will  be  of  opposite  sexes,  and  there  will 


FIG.  IO.      PLACENTA  OF  TWIN   PREGNANCY. 


be  two  distinct  placentas.  According  to  a  late  theory 
in  regard  to  the  cause  of  sex,  if  two  ova  are  discharged 
at  the  same  time  from  one  ovary  and  both  fecundated, 
the  children  will  be  of  the  same  sex.  Triplets  may  result 
from  the  fecundation  of  three  separate  ova  discharged 
at  the  same  time,  or  two  ova,  one  containing  a  double 
nucleus  and  nucleolus.  Quadruplets  result  from  fecun- 
dation of  four  distinct  ova,  the  two  ova  containing  a 
double  nucleus  and  nucleolus,  or  two  single  ova  and  one 
containing  a  double  nucleus  and  nucleolus. 


CHAPTER  III. 
Pregnancy. 

SIGNS  OF  PREGNANCY. 

The  signs  of  pregnancy  are  divided  into  positive  and 
presumptive.  The  positive  signs  are  the  fetal  heart  and 
ballottement. 

Fetal  Heart. — The  fetal  heart  is  heard  over  the 
abdomen  of  the  mother  as  soon  as  the  child  grows  to 


FIG    II.      LISTENING  FOR  THE  FETAI,  HEART. 


26  Obstetrical  Nursing 

sufficient  size  to  touch  constantly  the  wall  of  the  uterus, 
this  occurring  about  the  fourth  and  a  half  to  the  fifth 
month  of  gestation.  It  beats  from  120  to  160  times  to 
the  minute,  and  its  sound  has  been  likened  to  the  tick- 
ing of  a  watch  under  a  pillow. 

Ballottement  is  produced  somewhat  earlier,  and  is 
performed  by  placing  the  index  and  middle  fingers  in 
the  vagina  against  the  anterior  or  posterior  wall  of  the 
uterus;  a  quick  movement  of  the  fingers  upward  causes 
the  fetus  to  be  dislodged,  float  in  the  liquor  amnii,  and 
gravitate  back  against  them.  This  passive  movement  of 
the  fetus,  felt  by  the  examining  fingers,  is  ballottement. 

Presumptive  Signs. — The  presumptive  or  probable 
signs  of  pregnancy  are  many,  but  because  they  are 
present  in  other  conditions  besides  pregnancy  they  are 
not  positive  signs.  These  signs  can  be  best  remembered 
when  they  are  grouped  according  to  the  various  systems 
of  the  body,  namely,  those  affecting  the  geni to-urinary 
j  system,  the  digestive  system,  and  the  skin. 

GENITOURINARY  SYSTEM. 

Menses. — Cessation  of  menstruation  occurring  in  a 
woman  previously  perfectly  regular  is  one  of  the  earliest 
signs  of  pregnancy.  This  may,  however,  be  caused  by 
other  conditions  than  pregnancy,  as  an  altered  mode  of 
living,  change  of  climate,  exposure  to  cold,  or  illness  of 
an  acute  nature.  A  woman  may  be  pregnant  and 
menstruate  regularly  during  the  whole  of  gestation,  or 
during  the  early  months ;  hence  this  is  not  a  pathogno- 
monic or  positive  sign. 

Color  of  the  Vagina. — Soon  after  impregnation  the 
mucous  membrane  of  the  vagina  and  labia  takes  on  a 
purplish  hue,  due  to  obstructed  venous  circulation  from 
the  pressure  of  the  enlarging  uterus.     The  cervix  be- 


Obstetrical  Nursing  29 

Souffle. — The  uterine  souffle  or  bruit,  a  whirring 
sound  heard  over  the  uterus,  differs  from  the  fetal  heart- 
sound  in  that  it  is  synchronous  (occurs  at  the  same 
time)  with  the  mother's  heart-beat.  It  may  also  be 
found  in  large  fibroid  tumors  of  the  uterus.  It  is 
caused  by  the  rush  of  the  maternal  blood  through  the 
dilated  uterine  vessels. 

A  whirring,  blowing  sound,  not  nearly  so  loud  as 
the  uterine  souffle,  is  caused  by  the  rush  of  blood  through 
a  constriction  in  the  umbilicus,  or  cord,  and  is  called 
the  umbilical  or  funic  souffle.  It  is  synchronous  with 
the  fetal  heart-sounds. 

Bladder. — Irritability  of  the  bladder,  frequent 
desire  to  urinate,  is  one  of  the  first  symptoms,  and  is 
due  to  pressure  on  the  neck  of  the  bladder  by  the 
enlarged  and  heavy  uterus. 

THE  DIGESTIVE  SYSTEM. 

Morning  Sickness. — A  pregnant  woman  may  be  sub- 
ject to  a  slight  nausea  on  arising  in  the  morning,  nausea 
associated  with  vomiting,  either  of  the  first  meal  only 
or  a  vomiting  of  everything  ingested,  or  there  may  be 
a  constant  vomiting  of  fluid  and  mucus.  The  first 
named  is  alluded  to  as  the  morning  sickness,  and  is 
present  in  a  great  many  pregnant  women,  beginning 
immediately  after  conception  or  occurring  at  any  time 
during  the  first  six  weeks  of  pregnancy.  It  generally 
lasts  about  six  weeks,  but  when  present  constantly,  with 
retching  and  vomiting  of  fluid  and  mucus,  the  condition 
is  called  pernicious  vomiting,  the  patient's  life  being 
endangered.  This  requires  the  most  careful  attention 
and  treatment. 

Heartburn,  or  an  eructation  of  an  acid  solution  into 


30  Obstetrical  Nursing 

the  mouth,  is  a  frequent  occurrence  and  is  generally  due 
to  hyperacidity  of  the  gastric  juice.  It  can  be  combated 
by  antacids,  soda,  aqua  calcis,  aromatic  spirits  of 
ammonia,  and  the  magnesia  preparations,  either  the 
milk  of  magnesia  or  the  ordinary  cubes  of  carbonate  of 
magnesia  being  very  effectual. 

Salivation  consists  in  an  increased  secretion  of  the 
salivary  glands,  which  may  become  so  severe  as  to  keep 
a  patient  constantly  housed  because  of  the  profuseness 
of  the  flow.  If  this  saliva  is  swallowed  in  great  amounts 
it  is  frequently  the  cause  of  indigestion.  It  may  be 
associated  with  morning  sickness. 

Cravings. — Patients  frequently  have  peculiar  crav- 
ings for  unusual  things  to  eat,  fruits  out  of  season, 
sweets  or  acids,  either  of  which  may  be  unusual;  chalk, 
magnesia,  or  starch.  She  may  make  a  meal  of  a  single 
article  of  diet  which  ordinarily  is  not  cared  for  at  all. 

SKIN. 

Striae. — On  the  skin  of  the  abdomen  and  thighs  there 
develop  small  lines,  due  to  the  stretching  of  the  skin; 
they  are  the  strice,  or  technically  the  lines,  albicantes. 
In  a  primipara  they  are  blue  and  wide ;  after  birth  they 
become  narrow  and  pearly  white.  They  never  disap- 
pear. They  are  not  found  on  some  pregnant  women 
whose  skin  is  lax  and  stretches  easily. 

Pigment. — There  is  a  deposit  of  pigment  in  the  skin 
of  the  abdomen  in  its  median  line,  from  the  pubis  to  the 
umbilicus,  and  also  in  the  umbilicus.  The  umbilicus,  as 
the  abdomen  enlarges,  becomes  flattened  instead  of 
depressed.  Sometimes  a  deposit  of  pigment  occurs  in 
spots  upon  the  skin  of  the  body  and  face;  this  is  called 
chloasma.    It  disappears  soon  after  labor. 


Obstetrical  Nursing 


31 


OTHER  CHANGES. 

As  a  result  of  the  enlarging  uterus  the  movement  of 
the  diaphragm  downward  in  respiration  is  interfered 


FIG.  13.      PIGMENTATION  AND  STRI^. 

with,  and  daring  the  last  month  difficulty  in  breathing 
may  be  experienced. 

There  is  an  increase  in  the  quantity  of  blood  in  the 
system.  The  superficial  veins  of  the  body  are  frequently 
quite  markedly  enlarged — varicose  veins  developing 
oftenest  in  the  legs  and  vulva. 


32  Obstetrical  Nursing 

The  kidneys  are  much  overworked  during  pregnancy. 
The  quantity  of  urine  is  increased,  and  as  the  uterus 
enlarges  pressure  on  the  kidneys  and  their  vessels  causes 
a  congestion  and  a  condition  called  "pregnancy  kid- 
ney." Albumen  in  the  urine  is  a  danger  signal  of 
considerable  importance,  and  is  indicative  of  serious 
trouble  if  persistent  and  abundant. 

The  teeth  during  pregnancy  soften  and  break  down. 
Fillings  become  loosened  and  fall  out,  and  by  exposure 
the  nerves  become  painful.  Neuralgias  are  frequent, 
especially  of  the  face,  even  though  the  teeth  may  not  be 
involved.  The  patient  may  evince  many  signs  of 
nervousness ;  she  may  be  morose,  erratic,  or  irritable. 

The  thyroid  gland  frequently  enlarges  during 
pregnancy. 


DURATION  OF  PREGNANCY. 

A  nurse  having  been  selected  for  the  confinement, 
at  the  first  interview  with  the  patient  her  inquiry  is 
likely  to  be,  "From  what  time  do  you  wish  to  engage 
me  ? ' '  and  she  may  be  called  upon  to  assist  in  the  count. 
Pregnancy  lasts,  as  a  rule,  from  278  to  280  days,  forty 
weeks  or  ten  ordinary  menstrual  intervals,  but  if,  as 
is  occasionally  the  case,  a  known  intercourse  resulted 
in  impregnation,  the  duration  is  about  thirty-nine  weeks. 

It  is  very  important  that  all  menstrual  records  be 
kept  accurately,  as  it  is  of  assistance  to  the  physician 
in  checking  up  his  calculation,  but  it  is  surprising  how 
often  it  occurs  that  women  forget  the  date  of  their  last 
period.  Not  only  should  a  memorandum  of  the  first 
day  of  the  last  menstruation  be  kept,  but  any  change 
which  may  be  noticed  in  its  character,  duration,  amount 


Obstetrical  Nursing  33 

of  flow,  etc.,  as  it  frequently  happens  if  an  impregnation 
occurred  just  prior  to  a  menstrual  period  it  may  not 
stop  that  period  but  shorten  it,  or  the  amount  of  the 
flow  may  be  much  less.  No  method  of  calculation  is 
infallible,  but  the  one  which  is  most  often  correct,  if 
the  date  of  the  last  menstruation  be  known,  is  as  fol- 
lows: To  the  first  day  of  the  last  menstruation  add  the 
number  of  days  the  period  generally  lasts,  and  from 
this  date  count  back  three  months  or  forward  nine 
months. 

Take  as  an  example  December  1st  as  the  first  day 
of  the  last  period;  adding  seven  days,  the  usual  length 
of  the  flow,  brings  it  to  December  8th ;  counting  forward 
nine  months  or  back  three  months  makes  the  date  of 
probable  delivery  the  8th  of  the  following  September. 

There  are  many  tables  for  reckoning  the  date  of 
delivery,  but  these  are  all  based  upon  the  date  of  the 
last  menstruation  being  known,  this  being  given  on 
one  line,  the  date  of  labor  on  the  next. 

If  the  date  of  the  last  menstruation  is  not  known,  or 
if  a  patient  conceives  while  suckling  an  infant,  the 
menses  having  never  been  re-established,  there  are  two 
fairly  accurate  methods  of  determining  the  duration  of 
pregnancy.  One  of  these  is  by  counting  four  and  a 
half  months  from  the  date  quickening  is  first  felt,  or 
by  an  examination  of  the  abdomen.  The  fundus  of  the 
uterus  reaches  the  umbilicus  at  the  sixth  month;  by 
dividing  the  distance  from  the  umbilicus  to  the  ensiform 
cartilage  into  three  parts,  we  find  the  fundus  at  the 
lower  third  at  the  seventh  month,  at  the  middle  third 
the  eighth  month,  the  fundus  touching  the  ensiform 
cartilage  and  ribs  at  eight  and  a  half  months,  and  drops 
back  to  where  it  was  at  eight  months  a  short  while  be- 
fore full  time. 


34  Obstetrical  Nursing 

Two  hundred  and  seventy-eight  days  can  be  countea 
from  the  date  of  impregnation,  if  this  be  known. 

THE  CARE  OF  PREGNANCY. 

A  woman  during  pregnancy  should  exert  more  than 
usual  care  to  observe  the  common  laws  of  health  as 
relates  to  her  diet,  exercise,  rest,  clothing,  bathing, 
stomach,  bowels,  kidneys,  and  her  mental  condition. 

Diet. — Her  diet  should  be  the  most  nutritious  and 
varied  possible.  A  pregnant  woman  is  subject  to 
peculiar  cravings  of  appetite  of  an  abnormal  nature, 
which  under  ordinary  circumstances  are  never  present. 
She  craves  magnesia,  chalk,  pickles,  or  some  article 
which  is  usually  distasteful  or  never  eaten,  and  if  it 
is  shown  these  articles  do  not  upset  the  digestion  they 
need  not  be  especially  withheld.  Regular  meals  are 
important;  sweetmeats  and  eating  between  meals  should 
be  discouraged. 

There  is  no  special  or  restricted  diet  during  preg- 
nancy which  can  exert  any  effect  in  the  production  of 
an  easy  or  painless  labor.  Even  if  this  could  be  accom- 
plished, it  would  in  every  instance  be  at  the  expense  of 
the  newborn  infant,  which  would,  unquestionably,  be 
the  subject  of  some  nutritional  disorder. 

Meat  should  not  be  eaten  to  excess,  nor  more  than 
once,  or  at  the  most  twice  a  day;  fruit  can  be  eaten 
freely,  for  its  laxative  effect.  Vegetables  are  good  for 
the  pregnant  woman,  especially  spinach,  peas,  beans, 
and  tomatoes. 

Teeth. — The  teeth  during  pregnancy  are  liable  to 
become  defective,  and  if  troublesome  symptoms  arise, 
or  if  they  become  painful,  only  that  dentistry  should 
be   done   which   is   necessary   for  comfort.     Temporary 


Obstetrical  Nursing  35 

cement  fillings,  if  they  can  be  inserted  without  prolonged 
sittings,  for  the  protection  of  the  tooth  only,  are  entirely 
within  the  limits  of  safety.  Prolonged  dentistry  is  so 
wearing  upon  the  nervous  system  as  to  make  possible 
a  miscarriage,  and  teeth  should  not  be  extracted  unless 
absolutely  necessary. 

Exercise  is  essential  to  the  well-being  of  the  preg- 
nant woman,  and  as  a  general  rule  it  can  be  stated  that 
the  woman  who  gets  most  out-of-door  exercise  during 
gestation  will  have  the  most  vigorous  child  and  the  easiest 
labor.  The  amount  of  exercise  taken  will  depend  on 
the  individual,  but  as  a  general  rule  it  may  be  said  the 
exercise  must  be  short  of  fatigue  and  never  violent.  A 
woman  who  does  her  own  housework  will  not  be  so 
much  in  need  of  exercise  as  her  more  favored  sister, 
'as  she  is  frequently  tired  out  when  the  day's  work  is 
done,  but  she  does  need  fresh  air,  and  should  obtain 
this  in  winter  with  windows  open,  while  well  wrapped 
up,  and  in  a  sunshiny  room. 

Violent  exercise,  as  skating,  tennis,  golf,  dancing, 
swimming,  horseback  riding,  or  sewing  on  the  machine 
should  not  be  allowed.  The  patient  should  not  take 
long  journeys,  buggy  or  trolley  rides,  especially  at  the 
anniversary  of  a  menstrual  epoch. 

The  Clothing  should  be  very  warm  in  winter,  wool 
predominating,  and  very  light  in  summer.  A  freely 
acting  skin  is  most  important,  and  this  can  best  be 
obtained  by  warm  clothing  in  winter  and  frequent  bath- 
ing both  in  winter  and  summer.  Frequent  baths  in 
summer,  when  the  skin  is  naturally  more  active,  is  most 
essential. 

In  winter  the  lower  limbs  need  protection,  the  pro- 
jecting abdomen  preventing  the  close  application  of 
the  skirts  about  the  person,  and  even  though  close-fitting 


36  Obstetrical  Nursing 

warm  drawers  are  objectionable,  they  should  be  worn 
under  these  circumstances  if  the  weather  is  cold. 

Great  relief  will  be  observed  in  many  cases  if  the 
clothing  is  supported  from  the  shoulders,  because  of  the 
discomfort  produced  by  the  pressure  of  the  skirt-bands 
around  the  waist.  The  question  is  frequently  asked, 
"Are  corsets  not  injurious  during  pregnancy?"  If 
they  exert  any  pressure,  enough  to  feel  tight,  they  are 
certainly  injurious,  and  if  worn  should  contain  as  few 
steels  as  possible,  and  worn  only  for  the  purpose  of 
supporting  the  breasts  and  relieving  the  abdomen  of 
the  pressure  of  the  skirt  bands.  The  practice  of  wear- 
ing the  corsets  so  tight  as  to  crowd  the  enlarging  uterus 
down  into  the  pelvis  in  order  to  conceal  the  fact  that 
pregnancy  exists  is  reprehensible,  and  should  never  be 
done.  Great  harm  can  be  done  in  this  way  to  the  pelvic 
organs  and  to  the  growing  child. 

Certainly  no  pressure  should  be  exerted  over  the 
breasts ;  the  nipples  should  be  perfectly  free,  and  if  they 
are  normally  flat  or  depressed  an  effort  should  be  made 
during  the  whole  term  of  pregnancy  to  train  them  by 
massage  and  pulling  until  a  good  serviceable  nipple 
is  produced. 

High-heeled  shoes  should  not  be  worn,  as  they  are 
distinctly  injurious. 

Varicose  Veins. — One  of  the  few  complications  that 
will  prevent  one  from  walking  is  a  development,  during 
the  later  months,  of  varicose  veins  of  the  leg,  thighs,  and 
perhaps  of  the  vulva.  This  is  frequently  a  very  painful 
condition,  but  much  relief  may  be  obtained  by  wearing 
an  elastic  stocking  made  to  measure  by  any  good  surgical 
instrument  maker,  or  a  flannel  spiral  bandage,  the  latter 
lmving  to  be  replaced  as  often  as  it  becomes  loose.  The 
elastic  stocking  can  be  washed  frequently. 


Obstetrical  Nursing 


37 


FIG.   14.      TYPES  OF  ABDOMINAE  SUPPORTERS. 


38  Obstetrical  Nursing 

A  contributing  cause  to  the  development  of  varicose 
veins  of  the  leg,  and  one  not  usually  considered,  is  the 
wearing  of  the  encircling  elastic  garter  below  or  above 
the  knee.  This  form  of  garter  should  be  discarded  en- 
tirely during  pregnancy  and  the  stockings  supported  by 
the  suspender  garter. 

During  the  last  month  of  pregnancy  the  pressure  of 
the  descending  head  interferes  with  the  return  circula- 
tion, and  the  legs  become  swollen  and  frequently  pain- 
ful. From  the  seventh  month  to  full  term  the  weight 
of  the  child  on  the  abdominal  wall  causes  great  discom- 
fort, backache,  etc.,  and  this  is  greatly  relieved  by  the 
wearing  of  an  abdominal  supporter,  with  or  without 
perineal  straps,  as  they  are  found  needed. 

Bowels. — Most  women  are  constipated,  and  especi- 
ally so  during  pregnancy.  Daily  evacuations  from  the 
bowels  are  necessary  for  health  and  comfort,  and  must 
be  accomplished  either  by  diet,  medicines,  or  enemas, 
or  all  combined.  Those  foods  which  tend  to  increase  gas 
formation  should  be  used  but  little ;  fruits  are  excellent 
as  a  mild  laxative.  Abdominal  massage,  under  ordinary 
conditions  an  excellent  measure  for  constipation,  should 
not  be  used.  One  of  the  best  medicines  for  general  use 
is  cascara  sagrada,  of  which  there  are  many  agreeable 
preparations.  Enemas  should  not  be  given  too  fre- 
quently, but  they  are  occasionally  of  service.  Glycerin 
suppositories  are  ordinarily  quite  effectual  for  emptying 
the  rectum.  A  glass  of  water  before  breakfast  is  of 
service  in  obtaining  daily  evacuations.  This  can 
usually  be  taken,  provided  there  is  not  much  morn- 
ing sickness  or  salivation.  Diarrhea  may  occur 
from  a  previous  constipation  caused  by  indiscretions 
in  diet,  etc.,  and  when  present  should  receive  early 
medical  attention. 


Obstetrical  Nursing  39 

Kidneys. — It  should  be  borne  in  mind  that  a  preg- 
nant woman  excretes  or  throws  off  poisonous  and 
excrementitious  products  from  the  blood  for  herself 
and  for  the  child  in  the  uterus,  and  should  any  of  the 
avenues  of  escape  for  these  products  be  interfered  with 
her  health  will  suffer  in  consequence.  The  principal 
avenues  of  elimination  are  the  kidneys,  bowels,  skin, 
and  lungs,  and  any  impairment  of  function  of  any  one 
throws  extra  work  on  the  others,  to  their  detriment. 
Should  constipation  exist  for  any  time,  the  kidneys, 
already  burdened  by  a  double  amount  of  excretory  work 
and  suffering  from  pressure  by  the  enlarging  uterus, 
may  easily  fail  to  accomplish  their  full  quota  of  work, 
the  woman  suffering  in  consequence  from  retention  in 
the  blood  of  these  excrementitious  products. 

These  points  should  be  carefully  explained  to  the 
patient,  and  she  will  then  realize  the  importance  of 
sending  her  urine  to  her  physician  for  examination. 
The  urine  should  be  examined  every  two  weeks  from  the 
fifth  month  of  pregnancy,  and  once  a  month,  at  least, 
the  quantity  passed  in  twenty-four  hours  must  be 
measured  and  the  result  of  the  measurement  sent  to  the 
physician,  with  a  sample  of  the  twenty-four  hours' 
urine.  The  daily  quantity  should  be  at  least  forty 
ounces  to  be  within  the  limits  of  health.  The  presence  of 
albumen  in  the  urine  is  a  danger  signal  always,  and  a 
patient  so  suffering  should  be  placed  under  the  strictest 
surveillance  as  to  her  diet,  exercise,  bowels,  etc. 

Edema  of  the  feet  and  ankles,  alone,  may  occur 
from  pressure,  but  if  an  edema  of  the  hands  and  face 
is  also  present  the  urine  should  be  closely  and  frequently 
examined,  both  chemically  and  microscopically. 

One  of  the  first  evidences  of  failure  on  the  part  of 
the  kidneys  may  be  symptoms   of  toxemia,   persistent 


40  Obstetrical  Nursing 

headache,  dizziness,  disturbances  of  vision,  recurrent 
nausea  and  vomiting,  and  the  occurrence  of  any  of 
these  symptoms  should  be  reported  at  once  and  actively 
treated. 

Rest. — It  should  be  so  arranged  that  a  pregnant 
woman's  rest  is  not  disturbed  by  day  or  night.  A  nap 
during  the  day  should  be  encouraged.  During  the  later 
months,  because  of  the  pressure  of  the  enlarged  uterus 
on  the  diaphragm,  she  may  have  considerable  difficulty 
in  lying  upon  her  back,  and  will  have  to  be  content 
with  what  rest  can  be  obtained  while  propped  up  in  bed. 
Sleep  is  often  much  disturbed  also  by  the  great  activity 
of  the  child  at  night,  and  when  this  is  the  case  sleep 
during  the  day,  if  the  child  is  quiet,  is  necessary. 

Mental  Condition. — Our  patient  should  have  the 
most  pleasant  and  cheerful  surroundings  possible;  she 
is  very  liable  to  be  despondent  and  "blue,"  and  every- 
thing must  be  done  to  keep  her  thoughts  off  the  trying 
ordeal  she  will  soon  have  to  endure.  She  should  be 
guarded  most  assiduously  against  the  gossiping  women 
who,  under  the  cloak  of  friendship  and  interest,  detail 
to  her  all  the  disagreeable  complications  that  have  hap- 
pened to  friends  or  acquaintances  for  the  past  ten 
years.  These  stories  create  most  decided  impressions 
and  retard  progress  greatly. 

The  patient  should  keep  a  close  watch  upon  herself 
and  report  to  her  physician  as  soon  as  any  of  the  ordi- 
nary symptoms  of  pregnancy  become  troublesome,  but 
she  should  be  encouraged  not  to  become  hypochondriacal 
in  regard  to  herself.  She  should  be  able  to  strike  a 
happy  medium  between  the  harm  resulting  from  too 
great  self-examination  and  the  complications  resulting 
from  a  neglect  of  important  symptoms.  She  should  be 
warned    against    indiscriminate    reading    of    literature 


Obstetrical  Nursing  41 

bearing  on  pregnancy  and  labor,  as  there  are  very  few 
books  suitable  for  the  average  lay  mind  on  these  subjects. 

A  bright,  cheerful  room  should  be  chosen  for  the 
bedroom,  and  the  best  room  in  the  house  is  not  too  good 
for  the  lying-in  room  and  should  be  selected.  In  winter 
the  possibilities  of  heating  and  ventilation  should  be 
well  considered. 

Maternal  Impressions. — Of  the  many  superstitions 
which  surround  maternity,  none  is  so  deep-rooted  in  the 
laity,  perhaps,  as  the  belief  that  a  mental  impression 
can  produce  a  deformity  in  the  unborn  child.  Natural 
timidity  in  discussing  this  subject  deters  the  average 
mother  from  consulting  her  physician  in  regard  to  it, 
and  the  nurse  may  frequently  be  able  to  set  her  mind 
at  rest.  Cases  of  deformity  from  maternal  impressions 
have  never  been  scientifically  proven.  If  it  is  borne 
in  mind  that  the  child  is  practically  fully  formed  before 
the  end  of  the  third  month,  before  the  mother  is  abso- 
lutely sure  of  her  condition,  the  impossibility  of  a 
deformity  being  caused  by  the  sight  of  a  gruesome  object 
should  be  apparent  at  once.  Hence  the  nurse  can  in 
many  instances  reassure  the  mother,  and  banish  this 
dread  which  keeps  her  nervous  and  in  fear  through  the 
remainder  of  the  gestation. 

Bathing. — The  skin  is  one  of  the  principal  organs  of 
the  body  for  the  elimination  of  waste  products,  and 
during  pregnancy  it  is  most  important  that  it  be  kept 
in  good  condition.  The  body  should  be  protected  from 
chilling  as  pointed  out  in  the  section  on  clothing.  Daily 
baths  are  of  the  greatest  benefit ;  a  full  tub  bath  if  possi- 
ble, a  sponge  bath  if  a  tub  bath  can  not  be  had.  The 
temperature  of  the  bath  should  be  between  80°  and 
90°  F.,  extremes  of  temperature  being  avoided.  Cold 
plunges,  even  though  the  patient  is  accustomed  to  them, 


42 


Obstetrical  Nursing 


should  be  prohibited,  and  a  cool  sponge,  following  the 
tub  or  warm  sponge,  substituted.  A  pregnant  woman 
should  never  be  allowed  to  take  a  surf  bath. 

Chilling  of  the  body  from  exposure  of  any  kind 
throws  extra  work  on  the  kidneys,  and  serious  conse- 
quences may  result. 


Normal  "\.       ^^  Mushroom 

FIG.  15.      VARIOUS  FORMS  OF  NIPPIES  (a.  T.  B.  OBSTETRICS). 

Care  of  the  Nipples.— The  failure  of  a  mother  to 
nurse  her  infant  is  a  calamity,  and  every  precaution 
should  be  taken  to  enable  her  to  do  so.  The  wearing  of 
tight  clothing  before  and  after  puberty,  which  makes 
pressure  on  the  breasts  and  nipples,  causes  deformity 
of  the  nipples  and  prevents  nursing. 

The  breasts  of  every  pregnant  woman  should  be 
carefully  examined,  and  if  the  nipple  is  flat  or  depressed, 
instructions  given  in  the  massage  of  them  so  as  to  make 
serviceable  ones  out  of  them. 


Obstetrical  Nursing  43 

As  there  is  no  complication  which  can  happen  to  a 
nursing  mother  so  painful  and  troublesome  as  a  cracked 
or  fissured  nipple,  an  effort  should  be  made  before  con- 
finement to  prepare  them  for  nursing.  Alcohol  or 
preparations  containing  alcohol  are  injurious  rather 
than  helpful.  If  the  nipples  are  anointed  every  night 
with  lanolin,  and  as  part  of  the  morning  toilet  rubbed 
with  a  soft  nail  brush  or  rough  cloth  and  soap  to  remove 
the  lanolin  remaining,  the  nipples  are  much  more  pliable 
and  resistant.  This  treatment  was  first  suggested  by 
Dr.  J.  Milton  Mabbott,  and  has  proven  of  great  value. 


CHAPTER  IV. 

Labor. 

Labor  is  that  process  by  which  the  fetus,  placenta, 
and  membranes  are  expelled  from  the  uterus.  Why 
labor  should  occur  in  278  days  from  the  time  of  con- 
ception is  not  known,  though  there  are  many  attractive 
theories,  yet  unproved,  in  regard  to  it. 

There  are  certain  changes  which  take  place  about 
two  weeks  before  labor,  which  indicate  its  approach. 
The  fundus  of  the  uterus,  which  has  been  touching  the 
free  border  of  the  ribs,  descends  to  the  upper  third 
division,  between  the  navel  and  ensiform  cartilage,  be- 
fore referred  to.  This  descent  of  the  uterus  and  its 
contents  is  called  "settling,"  "dropping,"  "sinking," 
' '  falling, "  or  "  lightening, ' '  and  is  usually  an  important 
sign.  The  patient  is  much  more  comfortable,  her  waist 
bands  are  looser,  and  she  breathes  much  more  easily  and 
freely.  The  head  descending  into  the  pelvis  makes 
pressure  on  the  recurrent  blood-vessels  and  a  damming 
back  of  the  venous  blood  occurs,  usually  followed  by 
swelling  of  the  feet  and  legs,  and  perhaps  of  the  vulva 
also.  An  irritability  of  the  bladder  and  rectum  also 
results  from  this  pressure. 

Pains. — Throughout  the  wrhole  of  pregnancy  there 
is  a  rhythmical  contraction  and  relaxation  of  the  uterus, 
which  can  be  plainly  seen  by  close  inspection  of  the  bared 
abdomen  after  the  uterus  rises  out  of  the  pelvis.  These 
contractions  are  painless,  but  at  the  onset  of  labor  they 
become  painful  and  are  called  pains,  pain  being  used 
synonymously  with  uterine  contraction. 

At  the  eighth  month,  about  the  time  for  regular 
menstruation,    contractions    become    painful,    but   they 


Obstetrical  Nursing  45 

are  located  generally  in  the  abdomen,  radiating  perhaps 
to  the  thighs,  but  do  not  reach  the  back;  these  contrac- 
tions are  called  false  pains,  and  last  but  a  short  time  as 
a  rule.    No  other  symptoms  of  labor  are  present. 

True  labor  pains  begin  in  the  back  and  generally 
radiate  toward  the  front,  becoming  shortly  more  fre- 
quent, lasting  longer  and  of  greater  intensity.  As  the 
pains  increase  a  vaginal  discharge  appears,  at  first 
colorless,  later  tinged  with  blood,  which  comes  from  the 
rupture  of  minute  capillaries  in  the  dilating  cervix. 
This  blood-tinged  mucus  is  called  the  show. 

Stages  of  Labor. — Labor  is  divided  into  three  stages, 
called  respectively  first,  second,  and  third.  The  first 
stage  is  the  stage  of  dilation  or  preparation,  when  the 
cervix  softens  and  stretches  until  it  finally  disappears; 
it  begins  with  the  first  true  pains  and  ends  with  the  full 
dilation  of  the  cervix. 

The  second  stage  is  the  stage  of  expulsion;  it  begins 
with  the  full  dilation  of  the  cervix  and  ends  with  the 
birth  of  the  child. 

The  third  stage  is  the  placental  stage,  in  which  the 
placenta,  membranes,  and  cord,  all  being  spoken  of  as 
the  "afterbirth"  or  "secundines,"  are  born;  beginning 
with  the  birth  of  the  child  and  ending  with  the  birth  of 
the  placenta. 

In  a  primipara — a  woman  bearing  her  first  child — 
the  labor  is  longer  than  in  a  multipara — a  woman  who 
has  borne  at  least  one  child. 

The  nurse  is  sometimes  summoned  to  a  case  of  labor 
before  a  doctor,  but  more  frequently  after  he  has  been 
summoned  and  pronounced  the  patient  in  labor.  If  the 
nurse  arrives  first  she  should  begin  at  once  the  prepara- 
tion of  the  lying-in  room.  As  before  stated,  the  room 
selected  for  the  accouchement  must  be  the  brightest  in 


46  Obstetrical  Nursing 

the  house,  with  no  superfluous  hangings  to  the  bed — no 
canopy  or  valance.  It  is  much  better  to  have  the  de- 
livery upon  a  cot  or  lounge  and  remove  the  patient  to 
a  clean  bed  when  the  labor  is  over. 

Length  of  Labor. — In  a  primipara  the  first  stage 
lasts  from  six  to  twenty-four  hours,  the  second  from  one 
to  two  hours,  the  third  stage  from  fifteen  minutes  to 
half  an  hour. 

In  a  multipara  the  first  stage  lasts  from  two  to  ten 
hours,  the  second  stage  from  a  few  minutes  to  an  hour, 
the  third  stage  fifteen  minutes. 

The  dilatation  of  the  cervix  is  accomplished  in  several 
ways:  by  the  muscular  action  of  the  uterus,  by  the 
dilating  action  of  the  bag  of  waters,  or  amniotic  sac,  or 
if  this  ruptures  early,  by  the  presenting  part.  When 
the  membranes  rupture  early  in  labor  it  is  called  a 
dry  labor,  labor  under  these  conditions  being  generally 
slower  than  a  normal  one. 

The  contractions  of  the  uterus  force  a  small  portion 
of  the  bag  into  the  cervix,  and  this  wedge  being  con- 
tinuously forced  down  and  becoming  larger  and  larger, 
accomplishes  finally  the  full  dilatation. 

The  membranes,  if  they  have  not  ruptured  until  full 
dilation  has  been  accomplished,  may  rupture  spontane- 
ously or  be  ruptured  artificially  by  the  physician  with 
his  finger  or  a  sharp  instrument,  when  the  cervix  is 
fully  dilated.  If  the  child  is  born  with  the  membranes 
unruptured  and  covering  the  head,  it  is  said  to  have 
been  born  with  a  "caul,"  and  this  is  considered  a  lucky 
omen. 

Delivery  may  be  accomplished  with  the  mother  lying 
upon  her  back  (the  dorsal  or  lithotomy  position),  or 
upon  the  left  side,  a  position  like  the  Sims'  position. 

Presentation. — The   part   of  the   child  which   first 


Obstetrical  Nursing  47 

presents  at  the  inlet  of  the  pelvis  is  called  the  pre- 
senting part;  if  the  head  is  first,  it  is  called  a  vertex, 
or  head  presentation ;  if  the  face  presents,  a  face  presen- 
tation; if  the  buttocks  present,  a  breech  presentation; 
if  the  shoulder  is  felt  first,  a  transverse  or  shoulder 
presentation. 

Attitude. — The  attitude  of  the  child  is  the  relation 
which  each  of  its  members  bears  to  its  body;  the  chin 
is  flexed  on  the  chest,  the  arms  are  crossed  upon  the 
chest,  the  thighs  flexed  on  the  abdomen,  the  legs  on 
the  thighs,  the  feet  turned  up  until  the  back  of  the 
foot  touches  the  shin  or  tibia.  This  attitude  is  assumed 
so  the  child  will  occupy  as  little  space  in  the  uterus  as 
possible. 

Position  is  the  relation  which  a  fixed  point  on  the 
presenting  part  bears  to  various  fixed  points  in  the 
mother's  pelvis.  Let  the  antero-posterior  diameter  and 
the  transverse  diameter  of  the  pelvis  divide  the  brim 
into  four  equal  parts :  there  will  be  a  right  and  left 
anterior  quadrant,  and  right  and  left  posterior  quadrant. 
The  presenting  part  enters  the  pelvis  with  the  naming 
part  directed  toward  one  of  these  quadrants;  if  to  the 
front  on  the  left  side  it  is  called  the  left  anterior 
position.  The  naming  point  of  the  vertex  is  the  occipital 
bone  or  occiput ;  of  the  face,  the  chin  or  mentum ;  of  the 
buttocks  or  breech,  the  sacrum.  Hence  we  would  say 
the  vertex  is  presenting  in  the  left  occiput  anterior 
position  (L.  0.  A.)  when  it  is  directed  to  the  left 
anterior  quadrant;  the  child's  back  is  on  the  left  side 
of  the  mother,  directed  to  the  front. 

If  the  face  is  presenting  and  the  chin  directed  to 
the  left  posterior  quadrant,  it  is  the  left  mentum  pos- 
terior, or  L.  M.  P. ;  if  the  breech  is  directed  to  the  left 
anterior  quadrant  it  is  the  left  sacro  anterior,  or  L.  S.  A. 


48  Obstetrical  Nursing 

PREPARATION  FOR  LABOR. 

Nurse. — The  obstetrical  nurse  is  usually  engaged 
several  months  in  advance  of  labor,  and  arrangement 
made  as  to  when  the  engagement  is  to  begin.  It  is 
obviously  impossible  to  definitely  state  when  the  labor 
is  to  occur,  but  with  the  advice  of  the  physician  as  a 
guide  the  nurse  is  usually  engaged  several  days  in 
advance  of  that  date,  and  her  fees  begin  at  that  time. 

When  an  engagement  is  accepted  for  a  confinement 
case  it  should  always  be  with  the  understanding  that  no 
social  or  other  pleasures  shall  interfere  with  a  prompt  re- 
sponse to  the  call,  and  full  directions  must  be  given  when 
the  expected  time  of  delivery  approaches  where  a  call  can 
reach  her  if  away  from  home.  She  should  not  accept 
a  case  of  contagious  disease,  or  any  engagement  from 
which  she  can  not  be  released  on  the  first  call  from  the 
patient  in  labor. 

A  social  visit  should  be  paid  the  patient  for  mutual 
acquaintance,  and  occasional  visits  made  during  the 
remainder  of  the  pregnancy.  During  these  visits  many 
points  will  arise  for  discussion;  the  superstitions  and 
fears  in  regard  to  which  the  patient  through  delicacy 
hesitates  to  consult  her  physician ;  the  preparation  of 
herself  and  room  for  the  delivery,  and  the  infant's 
layette.  The  nurse  can  do  and  say  much  to  encourage 
the  patient,  can  give  her  instructions  as  to  the  symptoms 
of  the  onset  of  labor,  and  in  other  ways  assist  her. 

At  this  point  it  is  appropriate  that  a  word  be  said 
in  regard  to  the  nurse  herself.  The  nurse  who  makes 
a  good  impression  upon  the  patient  whom  she  nurses 
through  confinement,  and  upon  her  family,  will  have 
her  reputation  made  as  an  obstetrical  nurse,  for  there 
are  but  few  expectant  mothers  whose  choice  of  a  nurse 
is  not  influenced  to  a  great  extent  by  the  opinion  of 


Obstetrical  Nursing  49 

her  friends,  even  more  than  by  the  opinion  of  her 
physician.  The  physician  can  generally  tell  as  to  her 
professional  qualifications  and  capabilities,  but  the 
friends  can  tell  about  her  acceptability,  and  when  these 
are  weighed  in  the  balance  by  the  patient  the  accepta- 
bility outweighs  the  capability. 

Most  physicians  when  consulted  in  regard  to  the 
choice  of  a  nurse  generally  select  two  or  three,  taking 
into  consideration  the  household  circumstances  as  well 
as  the  possible  medical  emergencies,  allowing  the  patient 
to  engage  the  one  most  attractive  to  her. 

Qualifications. — What  then  can  be  said  are  the 
qualifications  most  necessary  to  make  a  good  obstetrical 
nurse,  other  than  her  professional  education?  She 
should  be,  above  all,  tactful,  adaptable,  diligent,  and 
cheery. 

The  tactful  nurse  is  able  to  make  a  place  for  herself 
in  the  home  of  the  millionaire  or  the  three-room  cottage 
without  disturbing  the  usual  routine,  and  with  equal 
ease.  She  should  be  able  to  leave  her  charge  bearing 
with  her  the  good- will  of  the  cook  and  the  other  servants 
of  the  house.  She  should  be  able  to  exclude  visitors 
from  the  lying-in  room  without  giving  offense  either  to 
the  patient  or  the  visitor,  until  the  physician  has  given 
his  consent  to  the  admission  of  company.  She  should 
cultivate  an  even  temper,  not  easily  ruffled  by  the 
annoyances  which  constantly  arise  in  the  sick-room  and 
in  the  house,  and  in  this  way  demonstrate  her  adapta- 
bility as  well  as  tact  fulness. 

She  must  be  diligent  in  her  most  exacting  duties, 
but  never  strict  enough  to  cause  the  patient  to  be  out 
of  humor,  oftentimes  being  able  to  accomplish  distaste- 
ful and  disagreeable  duties  by  the  exercise  of  tact  and 
patience.     She  should  never  be  autocratic  or  dictatorial. 


50  Obstetrical  Nursing 

Cheerfulness,  especially  in  the  face  of  emergencies, 
always  concealing  by  a  cheerful  exterior  any  trepidation 
or  alarm  which  might  be  felt,  is  a  most  necessary  quali- 
fication. 

Uniform. — The  nurse  should  appear  in  the  lying-in 
room  when  summoned  to  the  labor  clad  in  full  uniform, 
newly  washed,  with  sleeves  detachable  or  loose  enough 
to  be  easily  rolled  up,  and  always  wearing  a  cap,  which 
is  the  badge  of  her  authority.  Graduate  nurses  too 
soon  get  into  the  bad  habit  of  omitting  this  part  of 
their  uniform. 

She  should  be  amply  provided  with  clean  uniforms 
and  aprons,  never  wearing  a  soiled  apron  or  uniform. 
A  dressing  gown  of  soft  washable  material,  which  can 
be  worn  at  night  or  placed  by  her  bed  after  retiring,  to  be 
easily  slipped  on,  is  necessary,  as  she  may  expect  to 
be  called  frequently  after  the  baby's  birth. 

If  she  has  arrived  before  the  physician  she  should 
make  inquiry  in  regard  to  the  frequency,  character, 
location,  severity  and  duration  of  the  pains,  whether 
the  membranes  have  ruptured  and  if  the  show  has 
appeared.  If  she  can  judge  from  the  description  of 
the  patient  as  to  the  necessity  of  summoning  the  physi- 
cian at  once,  these  facts  should  be  written  down  and 
sent  by  messenger  to  the  physician,  or  if  there  is  but 
little  time — evidenced  by  the  great  rapidity  and  bear- 
ing-down character  of  the  pains — the  physician  should 
be  summoned  by  telephone. 

As  soon  as  the  nurse  has  arrived  and  donned  her 
uniform  (granted,  of  course,  that  she  has  time  for  this) 
and  obtained  the  information  for  the  physician,  she 
should  prepare  the  room,  the  bed,  and  the  patient  for 
the  delivery,  as  detailed  in  the  next  chapter.  If  the 
first  pains  have  wakened  the  patient  after  she  has  gone 


Obstetrical  Nursing  51 

to  bed,  the  bedclothes  must  be  removed  and  the  bed 
made  up  fresh,  as  described  elsewhere;  the  patient  pre- 
pared, and  the  special  articles  needed  in  the  room  placed 
close  at  hand. 

An  obstetrical  nurse  must  learn  above  all  things  the 
true  meaning  of  cleanliness  of  her  person  and  everything 
with  which  she  comes  in  contact,  both  in  and  out  of  the 
lying-in  room. 

Supplies. — The  supplies  needed  at  the  time  of  de- 
livery should  be  gotten  ready  several  weeks  in  advance, 
and  if  the  delivery  is  to  occur  at  home,  much  trouble 
and  some  money  can  be  saved  by  purchasing  an 
"Obstetrical  Outfit"*  containing  most  of  the  supplies 
needed.  The  outfit  suggested  by  the  author  contains 
the  following  articles : 

One-half  dozen  lochial  pads. 

Obstetrical  bed-pad. 

Five  yards  plain  sterilized  gauze. 

One-half  pound  absorbent  cotton. 

One  dozen  large  safety-pins. 

One  dozen  small  safety-pins. 

Fountain  syringe. 

Nail  brush. 

Nail  file. 

Antiseptic  soap. 

Antiseptic  tablets   (bichloride). 

Tube  white  vaseline. 

Vaseline. 

One  ounce  Squibb  7s  chloroform. 

Six  ounces  saturated  solution  boracic  acid. 

Sterilized  tape  for  cord. 


*This  is  prepared  by   C.   E.   Pfau,   druggist,    Third   and   St.    Catherine 
Streets,    Louisville,    in    a    hermetically    sealed   box. 


52  Obstetrical  Nursing 

Cord  dressing  (Balsam  Peru,  m.  xx;  01.  Ricini, 
oz.  1). 

Crede  eye  solution  (2  per  cent  nitrate  of  silver), 
1  drachm. 

Pipette. 

Fluid  extract  ergot,  1  oz. 

In  addition  to  this,  have  at  hand  one  dozen  towels; 
one-half  dozen  sheets ;  a  rubber  sheet  for  the  bed ;  two 
basins,  one  for  urine  or  vomit,  the  other  for  placenta; 
two  pitchers ;  one  small  bowl ;  an  old  carpet  or  rug,  to 
protect  the  floor  covering  alongside  the  patient's  bed; 
scissors ;  hot  and  cold  water ;  ice ;  a  small  table ;  a  blanket 
for  receiving  the  baby ;  scales ;  a  few  napkins  and  soft 
cloths ;  slop  jar,  with  top ;  chamber ;  abdominal  binder ; 
a  pair  of  cotton  leggins  long  enough  to  reach  to  the  hips 
and  large  enough  to  be  pulled  on  easily,  with  feet; 
tumbler ;  teaspoon ;  soap ;  boracic  acid  crystals  and  pow- 
der; hot- water  bag;  douche  pan;  rubber  and  glass 
catheter.  When  labor  approaches  the  kitchen  fire 
should  be  kept  up,  so  that  sufficient  hot  water  may 
be  had. 

The  Room. — It  must  be  previously  decided  where  the 
labor  is  to  occur — in  the  brightest,  cheeriest  room  in  the 
house,  warmest  in  winter  and  coolest  in  summer.  It 
should  be  accessible  to  the  bath-room,  for  convenience  of 
the  nurse.  Let  there  be  no  superfluous  hangings,  and 
no  cleaning  or  sweeping  done  in  the  room  immediately 
prior  to  the  delivery.  An  extra  old  rug  or  newspapers 
may  be  provided,  to  be  placed  at  the  sides  of  the  bed  or 
table  to  save  the  floor-covering  from  soiling  by  the  blood 
or  discharge.  The  room  should  contain  no  superfluous 
furniture ;  large  easy-chairs  replaced  by  straight-back 
ones ;  the  wTashstand  should  be  reserved  for  the  physician, 
and  contain  nothing  but  the  sterile  nail-brush  and  a 


Obstetrical  Nursing  53 

bowl  of  solution,  file,  soap,  hot  sterile  water,  and  a  basin 
of  lysol  or  bichloride  solution,  according  to  the  prefer- 
ence of  the  physician.  An  extra  small  table  must  be 
provided  for  dressings,  instruments,  and  other  material 
necessary.  A  lounge  can  be  placed  in  the  room,  to  be 
used  by  the  patient  for  resting,  in  order  not  to  disturb 
the  sterile  bed  when  it  is  made. 

The  Bed. — The  bed  should  be  moved  from  the  wall 
far  enough  to  permit  walking  around  it,  and  placed  in 
the  room  so  that  the  light  falls  upon  the  patient  prop- 
erly. Ample  light  is  an  essential,  and  should  influence 
the  selection  of  the  room.  It  is  much  better  to  keep  the 
bed  fresh  and  clean  for  the  patient  to  be  moved  to  after 
the  delivery,  hence  the  delivery  is  best  accomplished 
upon  a  lounge,  single  bed,  or  table.  If  delivered  upon 
the  bed  the  mattress  must  be  firm — never  a  feather  bed — 
and  over  this  is  placed  a  protecting  covering  made  either 
of  rubber  sheeting,  oil  cloth,  rubber  sheet,  a  number  of 
thicknesses  of  newspapers  sewed  together  and  covered 
with  an  old  sheet,  or  several  old  but  clean  comforts  or 
blankets.  The  protecting  covering  having  been  selected, 
the  bed  is  made  up  as  it  will  be  after  labor,  a  sheet 
covering  the  entire  mattress,  a  draw-sheet  folded  in  half 
and  pinned  on  each  side,  and  a  folded  sheet  placed 
where  the  hips  of  the  patient  will  lie.  If  the  delivery 
is  to  be  upon  this  bed,  it  is  covered  with  a  temporary 
or  removable  dressing,  consisting  of  a  rubber  sheet  which 
goes  all  across  the  mattress,  a  cotton  sheet,  and  pad,  all 
of  which  are  withdrawn  after  labor.  These  are  securely 
pinned,  to  prevent  wrinkling  and  slipping.  If  a  lounge 
is  to  be  used  for  the  delivery,  only  the  first  dressing 
named  need  be  adjusted.  For  receiving  the  discharges 
of  liquor  amnii  with  the  child,  and  the  blood  with  the 
placenta,  a  pad  made  of  absorbent  cheesecloth  filled  with 


54  Obstetrical  Nursing 

bran  can  be  used,  and  removed  on  the  completion  of  the 
third  stage. 

While  it  is  to  be  desired  that  the  mother  should  not 
be  disturbed  after  labor  for  the  changing  of  her  clothes, 
it  may  be  necessary,  and  they  should  be  kept  warm  and 
at  hand.  If  care  is  taken  in  most  cases  the  clothing  can 
be  kept  from  being  soiled,  as  it  is  desirable  that  the 
mother  be  moved  only  so  much  as  is  absolutely  necessary, 
because  of  the  tendency  to  hemorrhage  from  the  uterus 
when  not  perfectly  quiet. 

The  nurse  should  have  at  her  disposal  as  much  shelf 
room  and  drawer  space  in  bureau  or  chiffonier  as  needed, 
to  have  convenient  the  necessary  bed  linen,  together  with 
the  mother's  and  baby's  clothes. 

The  Patient. — As  soon  as  the  nurse  arrives  after 
the  onset  of  labor  and  has  prepared  herself,  if  there 
is  time  the  patient  should  always  be  given  a  full  bath 
in  the  tub,  no  matter  how  recently  she  may  have  taken 
one,  paying  particular  attention  to  the  cleaning  of  the 
vulva.  These  parts  should  be  sponged  off,  after  the 
bath,  with  the  antiseptic  solution  prepared  for  the  hands. 
A  warm  soapsuds  enema  should  also  he  given  if  there 
is  time.  If  not  time  for  both  the  bath  and  the  enema, 
give  the  enema  and  omit  the  bath,  but  cleanse  carefully 
the  vulva.  If  the  labial  hair  is  very  long,  it  will  be 
difficult  to  keep  clean  of  the  bloody  discharges  after 
labor,  and  should  be  clipped  close  with  the  scissors. 
The  nurse  must  also  be  sure  that  the  patient  has  emptied 
the  bladder  during  preparation.  The  shower  bath  is 
much  better  for  the  patient  than  the  full  tub  bath, 
owing  to  the  possibility  of  contamination  of  the  vagina 
while  sitting  in  the  tub. 

An  undershirt  is  put  on,  stockings,  and  slippers 
which  are  easily  removable,  a  night-gown,  and  wrapper 


Obstetrical  Nursing  55 

or  kimona.  The  patient  should  be  instructed,  not  to 
touch  the  vulva  after  this  preparation  under  any  cir- 
cumstances, and  if  bladder  or  bowels  are  evacuated 
the  nurse  should  be  allowed  to  cleanse  the  parts.  A 
vulval  pad  is  worn  as  a  protection  after  this  preparation. 

A  douche  should  never  be  given  by  the  nurse,  either 
in  the  preparation  of  the  patient  or  after  labor,  without 
specific  instructions  to  that  effect  by  the  physician, 
together  with  directions  as  to  its  character  and  temper- 
ature and  the  apparatus,  nozzle,  etc.,  to  be  used. 

If  the  patient  seems  in  active  labor  she  had  better 
be  kept  quiet,  lying  down,  until  the  physician  arrives 
and  directs  as  to  her  being  up.  If  he  so  directs,  the 
patient's  clothing  should  consist  of  stockings,  felt  or 
easily  removable  slippers,  the  gown  which  is  to  be  worn 
at  the  time  of  delivery,  and  a  dressing  gown,  with  a 
vulvar  dressing  provided  the  discharge  of  mucus  or 
water — if  the  amniotic  sac  has  ruptured — is  profuse. 
Her  hair  should  be  braided  in  two  plaits  if  there  is 
enough  of  it,  as  it  is  much  more  comfortable  when  lyin*? 
down  fixed  in  this  way  than  wThen  it  is  done  up  on  the 
head.  While  waiting  for  the  doctor  the  nurse  should 
explain  to  the  patient,  if  she  be  a  primipara,  the  ne- 
cessity of  a  vaginal  examination.  If  the  necessity  for 
this  is  understood  by  the  patient  before  it  is  attempted 
it  will  save  her  much  distress  of  mind. 

The  Examination. — For  the  abdominal  examination 
and  measurement  of  the  pelvis  (if  the  latter  has  not 
already  been  made)  the  patient  lies  evenly  upon  her 
back  close  to  the  edge  of  the  bed,  and  the  abdomen  from 
the  ensiform  cartilage  to  the  pubes  is  bared.  From  the 
abdominal  examination  the  position  and  presentation 
of  the  child  is  learned  and  the  fetal  heart  is  located. 
If  the  ear  is  used  for  this,  the  abdomen  is  covered  with 


56 


Obstetrical  Nursing 


a  layer  of  gauze,  and  left  bare  if  the  stethoscope  is 
used. 

For  the  vaginal  examination  the  nurse  should  inquire 
if  the  doctor  uses  his  right  or  left  hand,  and  place  the 


FIG.  l6.      PATIENT  ON  HER  BACK — MEASURING  TRANSVERSE 

DIAMETERS. 

patient  upon  the  proper  side  of  the  bed.  The  patient 
lies  upon  her  back,  knees  drawn  up  and  wide  apart, 
and  the  vulva  is  thoroughly  cleansed  with  absorbent 
cotton  wet  with  an  antiseptic  solution.     The  patient  is 


Obstetrical  Nursing 


57 


best  covered  with  two  folded  sheets  which  overlap  on 
a  line  with  her  hips;  when  ready  for  the  examination 
the  lower  sheet  is  slipped  down,  thus  exposing  the  vulva, 


FIG.  17.      PATIENT  ON  HER   SIDE — MEASURING  THE  ANTERO- 
POSTERIOR AND  OBLIQUE  DIAMETERS  OF  THE  PEIVIS. 

the  upper  sheet  covering  the  thighs,  or  she  may  be 
covered  entirely  by  one  sheet,  the  vulva  exposed  when 
ready  for  the  examination.  Whenever  lying  down  the 
patient's  clothing  should  be  pushed  well  up  under  her 


58  Obstetrical  Nursing 

shoulders,  in  order  to  protect  them  from  being  soiled 
by  the  escaping  discharges. 

A  basin  of  warm,  filtered,  sterile  water,  or  if  this 
is  not  obtainable,  boiled  and  strained  water,  must  be 
provided  for  the  physician  to  prepare  his  hands,  with 
a  sterile  nail-brush,  antiseptic  soap,  and  nail  file.  Be 
ready  to  frequently  change  the  water  he  uses,  the  nurse 
then  to  re-sterilize  her  hands.  Place  a  chair  by  the 
bedside  facing  the  head  of  the  bed;  have  unguent  ready 
for  physician's  examining  fingers — sterile  vaseline  which 
is  contained  in  the  collapsible  tubes  being  best.  This 
is  used  only  to  protect  the  back  of  the  fingers  about  the 
nails,  the  natural  secretions  of  the  vagina  acting  as  a 
lubricating  agent.  Lard  which  has  been  placed  in  an  un- 
sterilized  saucer  should  not  be  used.  Many  physicians 
use  freshly  sterilized  rubber  gloves  in  obstetrical  work, 
and  these  must  be  boiled  by  the  nurse  while  the  physi- 
cian's hands  are  being  prepared. 

Hands  can  be  sterilized  by  the  aseptic  or  the  anti- 
septic method,  or  by  a  combination  of  both.  By  asepsis 
we  mean  the  removal  of  germs  by  mechanical  methods 
entirely — a  brush  and  plenty  of  soap  and  water.  By 
the  antiseptic  method  cleanliness  is  obtained  with  soap 
and  water,  assisted  by  the  use  of  antiseptic  drugs. 

The  hands  should  be  washed  in  running  water  where 
this  is  obtainable,  and  where  it  can  not  be  had,  washed 
through  several  basins  of  water.  Special  attention  must 
be  given  to  scrubbing  of  the  finger  nails  and  the  spaces 
under  them,  which  is  the  most  difficult  portion  of  the 
hand  to  sterilize. 

It  must  be  borne  in  mind  that  when  the  hands  are 
once  sterilized  nothing  should  be  touched  which  is  not 
sterilized  as  thoroughly  as  the  hands  have  been.  A  bowl 
of  warm  antiseptic  solution  should  be  kept  convenient, 


Obstetrical  Nursing 


59 


for  frequent  rinsing  of  the  hands.  This  may  be  a  solu- 
tion of  bichloride  of  mercury,  1-5,000;  carbolic  acid, 
1-40;  of  creolin,  a  somewhat  ill-smelling;  coal-tar  prep- 


FIG.   l8.      VAGINAL  EXAMINATION. 

aration,  but  an  effectual  antiseptic;  or  a  solution  of 
lysol,  which  is  a  very  convenient  and  efficient  antiseptic. 
Because  of  the  convenience  of  preparation,  bichloride  of 
mercury  is  generally  used,  being  made  by  dissolving  a 
bichloride  tablet  in  one  pint  of  water,  thus  obtaining  a 
1-1,0Q0  solution,  which  can  be  diluted  as  desired. 


60  Obstetrical  Nursing 

If  the  nurse  has  any  trouble  with  her  hands  which 

prevents  their  thorough  scrubbing  she  should  provide 

herself  with  a  pair  of  sterile  rubber  gloves,  to  be  worn 

during  the  delivery  and  whenever  any  vulvar  dressings 

are  done. 

THE  LAYETTE. 

As  soon  as  a  woman  decides  she  is  pregnant  for  the 
first  time  her  thoughts  begin  to  dwell  upon  the  prepa- 
rations necessary  for  the  little  visitor,  its  basket  and 
dainty  layette.  If  she  has  borne  children  she  will  more 
than  likely  have  saved  the  outfit  of  the  previous  child. 

Clothes. — In  designing  the  clothing  for  an  infant 
everything  must  be  loose,  unrestraining  to  the  motions 
of  the  body  and  extremities,  and  not  interfering  with 
its  functions.  The  clothing  must  be  of  a  weight  suffi- 
cient to  maintain  the  body  heat,  but  not  burdensome. 
This  rule  will  not  permit  the  use  of  tight  bands  on 
newborn  babies,  a  barbarous  custom  which  is  still  being 
practiced.  Instead  of  preventing  rupture  or  hernia, 
tight  bands  frequently  produce  this  condition. 

No  attempt  will  be  made  to  describe  in  detail  the 
making  of  a  baby's  garment  or  to  suggest  a  pattern, 
fashions  changing  in  babies'  clothes  as  they  do  in  adults. 
As  soon  as  the  binder  is  discarded  after  the  falling  of 
the  cord  it  should  be  dispensed  with  entirely;  in  its 
place  a  knit  band  with  shoulder  straps  is  worn  next  the 
skin,  which  can  be  kept  from  riding  up  under  the  arms 
by  being  pinned  to  the  napkin. 

Socks,  the  one  article  of  wearing  apparel  with  which 
a  newborn  baby  is  overwhelmed  by  its  admiring  friends, 
are  about  as  useless  as  they  are  popular  as  a  gift.  They 
do  no  good,  are  never  on  properly,  never  fit,  and  are 
always  being  kicked  off  and  getting  lost.  The  skirts 
should  be  of  sufficient  length  to  protect  the  feet  and  legs. 


Obstetrical  Nursing  61 

A  child  should  be  undressed  at  night  and  attired  in 
its  nightdress,  which  with  its  shirt  and  napkin  are  all 
the  clothes  worn.  It  should  be  covered  with  sufficient 
bedclothes  to  keep  it  warm,  these  being  secured  by  tapes 
or  large  safety-pins  to  keep  it  from  kicking  out,  as 
babies  are  prone  to  do  very  early  in  life. 

A  box  or  special  drawer  should  be  provided  for  the 
baby's  clothes.     The  outfit  consists  of  the  following: 

Six  straight  bands,  18  inches  long,  4%  to  5  inches 
wide,  made  of  soft  baby  flannel.  (These  are  to  be  worn 
until  the  cord  drops  off.) 

Four  dozen  napkins,  made  of  cotton  birdseye,  two 
sizes,  20  inches  and  24  inches  wide.  Either  square  or 
double. 

Six  flannel  skirts. 

Four  knit  bands. 

Four  outing  flannel  gowns. 

Nine  white  slips,  nainsook  or  longcloth. 

Three  white  cambric  petticoats  (to  be  worn  only  in 
summer,  and  not  with  flannel  ones). 

Two  white  baby-blankets  or  comforts. 

Two  knitted  sacks. 

Two  or  three  quilted  pads  for  baby's  bed,  one  yard 
square. 

One  or  more  cloaks  and  caps — one  veil. 

Two  pieces  rubber  cloth,  one  yard  square. 

Fine  hair  pillow,  10x12  inches,  for  buggy. 

Six  pillow  slips. 

Six  sheets  for  bassinet. 

Skirt  stretcher. 

Stocking  stretcher,  for  drying  these  garments  with- 
out shrinking  them.  If  the  directions  for  washing  flan- 
nels given  in  Appendix  are  followed,  stretchers  will 
not  be  needed. 


62  Obstetrical  Nursing 

One  flannel  bag  for  tying  about  child's  waist  when 
out  of  doors. 

The  Basket. — The  baby's  basket  may  be  made  as 
elaborate  as  the  means  will  allow,  but  a  serviceable  and 
dainty  one  may  be  made  of  any  shallow  basket,  lined 
with  muslin  over  any  color,  in  which  are  pockets  and  pin- 
cushions filled  with  pins.  A  basket  of  the  hamper 
pattern  is  very  useful,  the  top  containing  the  small 
articles,  the  bottom  used  for  supplies.  They  may  stand 
upon  legs,  the  right  height  to  make  it  easy  to  reach  into 
while  holding  the  baby  upon  the  lap ;  if  not  on  legs  the 
basket  can  be  placed  on  a  chair  in  easy  reach.  The  con- 
tents of  the  basket  should  be  those  things  which  are 
needed  for  the  baby's  first  bath,  among  which  are  the 
following : 

Pin-cushion,  containing  three  sizes  of  safety-pins. 

Soft  hair  brush. 

Soap  box,  with  white  castile  soap. 

Talcum  powder  in  box  with  perforated  top.  (Powder 
puff  is  unhygienic.) 

White  vaseline  in  tube. 

Benzoinated  oxide  of  zinc  ointment. 

Bath  thermometer. 

Hot-water  bag,  two-quart,  with  removable  flannelette 
bag  with  draw-string. 

Saturated  solution  of  boracic  acid. 

One  pair  blunt  scissors. 

Absorbent  cotton,  wrapped  in  small  towel. 

Soft  towels  made  of  old  damask. 

Apron  bath  blanket  of  outing  flannel,  made  of  two 
thicknesses  sewed  together  at  the  top  only. 

Wooden  toothpicks,  to  be   wrapped   with   absorbent 
cotton  at  one  end  and  used  as  swab  for  cleaning  nose. 
Two  or  three  thin  flannel  bands,  six  inches  wide. 


Obstetrical  Nursing  63 

Soft  linen  of  double  thickness,  or  cheesecloth,  for 
wash  cloths. 

Squares  of  sterile  gauze  for  washing  mouth. 

Medicine  dropper. 

The  double  apron  referred  to  may  be  placed  in  the 
basket  for  convenience,  and  before  the  bath  is  begun  all 
the  clothes  to  be  put  on  the  baby  placed  within  easy 
reach. 

The  bath-tub  most  commonly  used  for  babies  is  the 
tin  tub  the  size  of  an  adult's  foot-tub,  or  one  made  of 
papier-mache,  the  latter  having  the  advantage  of  light- 
ness. The  tub  of  the  greatest  utility  is  one  made  of 
rubber  sheeting  tacked  to  a  wooden  folding  frame,  the 
latter  being  easily  made  by  any  carpenter.  This  should 
be  of  a  height  which  does  not  necessitate  leaning  over 
when  giving  a  bath,  and  can  be  folded  up  and  put  away 
when  not  in  use. 

Care  of  Napkins. — Too  great  emphasis  can  not  be 
laid  on  the  importance  of  careful  washing  of  the  nap- 
kins, both  when  soiled  with  a  movement  from  the  bowels 
and  when  wet  with  urine  only.  They  should  be  washed 
in  hot  water  with  soap  and  borax,  followed  by  several 
rinsings  in  cold  water,  and  dried  outside  of  the  nursery; 
then  either  folded  smoothly  by  hand  or  ironed.  We  have 
seen  several  cases  of  severe  eczema,  limited  to  that  part 
of  the  body  covered  by  the  napkin,  where  inquiry  de- 
veloped the  fact  that  the  napkin  was  being  used  after 
being  wet  three  or  four  successive  times  and  simply 
dried  without  washing. 

As  soon  as  a  napkin  is  soiled  it  should  be  taken  to  the 
bath-room  or  closet  and  the  movement  scraped  off  with  a 
knife  kept  for  that  purpose,  wiping  the  scrapings  on  a 
piece  of  toilet  paper  and  throwing  it  in  the  closet.  The 
diaper  is  then  put  in  a  covered  porcelain  bucket  or  slop 


64  Obstetrical  Nursing 

jar,  which  should  be  provided,  containing  a  weak  formal- 
dehyde solution  or  a  1  to  100  carbolic  acid  solution,  in 
which  the  soiled  napkins  can  be  placed  until  washed. 

The  Nursery. — The  nursery  should  be  a  bright, 
cheery  room,  with  well  screened  open  fireplace  for  winter 
heating,  if  possible.  The  temperature  should  not  be 
over  70°  F.,  and  the  air  changed  at  least  once 
daily,  first  removing  the  child  and  opening  all  windows 
for  a  half  to  one  hour.  It  should  have  not  less  than 
1,000  cubic  feet  of  air  space,  and  more  if  possible. 
Emphasis  should  be  laid  upon  the  importance  of  moist 
air  in  steam-heated  or  hot-air-heated  houses. 

The  walls  should  by  preference  be  painted  and  the 
floor  uncarpeted,  either  hardwood  or  painted.  This 
makes  it  possible  for  the  floor  to  be  wiped  up  and  not 
swept,  thus  avoiding  dust.  The  use  of  the  Cleanator  or 
other  compressed-air  cleaning  devices  in  private  houses 
should  be  recommended,  especially  where  there  are 
children.  There  should  be  plenty  of  light  when  the 
child  is  awake,  with  dark  shades  to  darken  the  room 
when  asleep,  and  the  room  should  be  at  least  five  degrees 
cooler  at  this  time.  In  favorable  weather  the  child  can 
sleep  in  its  buggy  out  of  doors,  protected  from  the  wind 
and  its  eyes  protected  from  the  light. 

A  baby's  scale  should  be  in  every  nursery — the 
grocer's  balance  scale  being  the  most  reliable. 

In  addition  to  this,  the  following  conveniences  should 
be  in  the  nursery : 

A  screen  for  protection  of  child  from  light  and 
draughts. 

Low  chair,  without  arms. 

Basket  for  soiled  linen  (not  the  napkins). 

Basin  and  pitcher. 

Hot-water  bag. 


Obstetrical  Nursing  65 

CONDUCT  OF  LABOR. 

First  Stage. — During  the  first  stage  the  patient 
walks  as  much  as  possible,  and  the  nurse  should  support 
her  if  need  be,  helping  her  to  a  chair,  the  foot  of  the 
bed,  or  other  fixed  object,  for  support  at  the  onset  of  a 
pain.  The  pains  of  the  first  stage  are  generally  more 
vigorous  when  the  patient  is  walking  about.  When 
they  begin  she  grasps  any  stationary  object  for  support 
and  ease  during  the  pain.  Instructions  have  already 
been  given  as  to  the  preparation  of  the  patient  for 
this  stage. 

Her  diet  should  be  light — milk,  milk-toast,  cocoa  or 
chocolate,  and  even  if  there  is  a  distaste  for  food,  if 
the  first  stage  is  prolonged  she  should  be  persuaded  to 
take  some  nourishment.  There  may  be  vomiting  during 
labor,  but  this  does  not  usually  occur  until  the  latter 
part  of  the  first  or  during  the  second  stage. 

Second  Stage. — As  soon  as  the  second  stage  is 
reached,  which  generally  is  manifested  by  pains  coming 
closer  together,  more  bearing  down  and  expulsive  in 
character,  of  longer  duration  and  much  more  painful, 
the  patient  is  put  to  bed. 

The  patient  during  this  stage  may  desire  something 
to  pull  against,  and  the  husband  may  be  called  upon 
to  give  his  hand  for  this  purpose.  A  folded  sheet  may 
be  tied  to  the  foot  of  the  bed  to  relieve  the  nurse  of  this 
pulling.  Rubbing  the  back,  or  simply  the  pressure  of 
the  hand  on  the  back  during  the  height  of  a  pain,  may 
give  some  relief. 

As  the  head  presses  upon  the  bladder  and  rectum 
the  patient  complains  of  a  desire  to  evacuate  these 
organs,  but  she  should  not  under  any  circumstances  be 
allowed  to  get  up,  but  told  the  bed  is  protected  from 
soiling  and  to  evacuate  in  the  bed.     During  the  perineal 


66 


Obstetrical  Nursing 


stage  (as  the  head  is  being  forced  over  the  perineum) 
the  patient  should  have  some  chloroform  to  prevent  any 
unusual  effort  at  bearing  down,  as  any  sudden  expul- 
sive effort  might  tear  the  perineum  badly.  Chloroform 
is  best  administered  on  the  Esmarch  inhaler  or  mask, 
fifteen  or  twenty  drops  being  dropped  on  the  mask  and 
then  placed  on  the  patient's  face  as  the  pain  begins. 


FIG.   19.      ESMARCH  CHLOROFORM    INHALER  AND  BOTTLE. 

This  produces  anesthesia  to  the  obstetrical  degree  only, 
the  patient's  sensibilities  being  obtunded  and  the  keen 
edge  of  the  pain  removed.  If  an  obstetrical  operation 
is  performed  the  anesthesia  is  much  more  profound,  be- 
ing to  the  full  surgical  degree.  A  physician  is  usually 
called  in  to  give  the  anesthetic  if  it  is  required  for  an 
operation. 

One  of  the  nurse's  hands  should  rest  on  the  fundus 
of  the  uterus,  to  cause  it  to  contract  down  upon  the  body 
of  the  child  as  the  head  is  being  born.  If  this  is  not 
done  the  uterus  does  not  contract,  and  when  the  body 
is  born  air  enters  the  uterus  with  a  rush;  a  blood-clot 
can  easily  be  thus  formed,  taken  up  by  the  uterine  cir- 
culation, and  cause  severe  complications. 


Obstetrical  Nursing 


67 


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68  Obstetrical  Nursing 

The  patient  is  generally  upon  her  back  throughout 
the  second  and  third  stages  of  labor,  especially  in  this 
country,  but  in  England  and  on  the  Continent  is  gener- 
ally upon  the  left  side,  a  modified  Sims'  position.  This 
is  spoken  of  as  a  left  lateral  delivery.  If  upon  the  left 
side  for  the  birth  of  the  child,  the  patient  is  generally 
turned  over  on  her  back  for  the  completion  of  the  third 
stage. 

As  soon  as  the  head  is  born  the  accoucheur  feels  for 
a  coil  of  cord  which  is  frequently  around  the  neck  of  the 
child,  and  if  found  it  is  immediately  removed,  as  traction 
enough  to  rupture  the  cord  would  be  made  if  it  is  allowed 
to  remain,  or  the  traction  might  cause  a  premature 
separation  of  the  placenta. 

With  the  birth  of  the  head,  the  chloroform  mask  is 
removed.  While  one  hand  still  holds  the  uterus,  the 
unengaged  one  reaches  for  the  gauze  with  which  the 
child's  eyes  and  mouth  are  wiped  out,  hands  the  basin 
containing  tape  for  tying  the  cord,  or  the  funis  band 
applicator  and  the  scissors,  to  the  physician.  These 
should  be  close  at  hand  on  the  small  table,  within  easy 
reach.  In  addition  to  this  a  small  foot-tub  or  large 
basin  should  be  provided,  containing  warm  water,  in 
which  the  child  can  be  immersed  if  it  does  not  breathe 
and  cry  promptly.  As  soon  as  respiration  is  established 
the  child  is  covered,  to  protect  it  from  exposure. 

Tying  the  Cord. — Two  ligatures  are  generally  placed 
on  the  cord,  about  half  an  inch  apart,  the  cord  being 
cut  between  these  ligatures.  The  one  next  the  child  is 
tied  in  order  to  keep  it  from  bleeding,  that  next  the 
placenta  to  prevent  the  blood  in  the  placenta  and  cord, 
which  would  drain  out,  from  escaping  and  soiling  the 
bed.  The  stump  of  the  cord  is  left  about  two  inches 
long. 


Obstetrical  Nursing  69 

The  material  for  ligature  may  be  either  tape,  strong 
twine,  or  rubber  band,  the  latter  being  very  much  pref- 
erable as  it  exerts  continuous  pressure,  continuing  it 
while  the  Wharton's  jelly  is  drying  up. 

As  soon  as  the  cord  is  severed  the  physician  relieves 
the  nurse  of  holding  the  uterus,  and  she  is  free  to  take 
the  baby.  If  it  has  cried  lustily  it  is  wrapped  in  a 
blanket,  laid  on  its  right  side,  and  placed  in  a  warm 
place  until  the  mother  is  put  to  bed — and  not  where  it 
may  be  sat  on. 

Caul. — It  happens  very  infrequently  that  the  mem- 
branes rupture  spontaneously  high  up  beyond  the  di- 
lated cervix,  allowing  most  of  the  liquor  amnii  to  escape, 
and  when  the  child  is  born  its  head  and  face  are  encased 
in  membrane,  which  is  popularly  called  a  caul.  This 
may  also  happen  with  a  small  premature  child,  where 
we  have  a  child,  placenta,  and  membranes  born  together, 
the  membranes  unruptured.  Should  this  occur  the  mem- 
branes must  be  ruptured  at  once,  to  enable  the  child  to 
breathe. 

Third  Stage. — The  third  stage  begins  with  the  birth 
of  the  child  and  ends  with  the  birth  of  the  placenta  and 
membranes.  The  placenta  may  be  born  fetal  surface 
first  and  out,  which  is  the  most  favorable  way ;  edge  first, 
fetal  surface  out;  maternal  surface  first  and  out,  or 
edge  first,  maternal  surface  out. 

The  uterus  is  held  by  the  nurse,  continuously,  after 
the  birth  of  the  child,  until  relieved  by  the  physician. 
It  feels  about  the  size  of  a  cocoanut,  and  should  remain 
firm  and  hard.  If  it  becomes  relaxed  or  soft,  and  there 
is  a  continuous  flow  of  blood,  the  physician  should  be 
notified  at  once.  Rubbing  and  kneading  the  fundus 
will  usually  cause  it  to  contract  again  on  the  placenta 
and  stop   the  bleeding.     The   pulse  should  be   felt   oc- 


70  Obstetrical  Nursing 

casionally,  and  if  it  becomes  unduly  accelerated  the 
physician  notified. 

The  placenta  may  be  born  spontaneously  or  be  as- 
sisted by  the  Crede  method,  which  consists  in  backward 
and  downward  pressure  on  the  uterus  during  a  con- 
traction. The  cord  is  never  pulled  upon  to  assist  in  the 
delivery  of  the  placenta,  as  this  may  cause  an  inversion 
of  the  uterus,  which  is  a  turning  of  this  organ  wrong- 
side  out. 

When  the  fundus  of  the  uterus  is  felt  to  rise  above 
the  umbilicus  and  several  inches  of  the  cord  seen  to 
emerge  from  the  vulva,  it  is  a  sign  that  the  placenta 
has  become  separated,  and  the  Crede  method  of  delivery 
can  be  employed.  This  usually  occurs  in  from  fifteen 
to  twenty  minutes. 

A  basin  is  placed  on  the  bed  close  to  the  vulva,  the 
free  end  of  the  cord  placed  in  it  ready  to  receive  the 
placenta,  which  with  some  fluid  blood  is  caught  and 
laid  aside  until  the  physician  can  examine  it  and  the 
membranes  to  see  if  they  are  complete. 

The  nurse  then  bathes  the  mother,  using  a  weak 
antiseptic  solution,  paying  particular  attention  to  the 
vulva  and  the  hair  of  the  labia.  The  blood  is  much 
more  easily  removed  at  this  stage  than  later,  when  it 
has  clotted  upon  the  hair. 

As  soon  as  the  placenta  is  born,  the  preliminary 
cleansing  finished,  and  a  fresh  sterile  sheet  or  towel 
spread  under  the  buttocks,  the  physician  investigates 
the  perineum  and  posterior  vaginal  walls  for  possible 
lacerations.  If  a  laceration  is  present  it  should  be 
repaired  immediately.  This  operation  of  perineorrhaphy 
is  considered  under  the  chapter  on  Operative  Obstetrics. 

The  patient  cleansed,  the  vulva  is  protected  by  a 
sterile   gauze   pad,   which   is   changed   often   enough   to 


Obstetrical  Nursing 


71 


protect  the  bed  from  soiling.     The  flow  is  much  greater 
the  first  few  hours  than  afterward.     The  pads  are  gener- 


FIG.  21.   BAND  FOR  RETAINING  ISCHIAL.  PADS. 

ally  changed  every  two  hours  during  the  first  twenty- 
four,  and  more  infrequently  after  this. 

With  the  completion  of  the  third  stage  the  labor  is 
over,  and  the  puerperium  has  begun. 


CHAPTER  V. 
The  Puerperium. 

The  puerperium,  or  lying-in  period,  is  the  time  taken 
by  Nature  for  the  uterus  to  contract  down  until  it  rests 
entirely  within  the  pelvis.  Ten  days  or  two  weeks  is 
generally  the  time  spent  in  the  recumbent  position, 
though  no  hard  and  fast  rules  can  be  made  as  to  this. 

The  Nurse's  Duties  during  this  time  are  manifold 
and  varied.  She  is  responsible  for  the  lying-in  room 
and  for  the  condition  of  the  mother  and  child.  The 
mother,  as  soon  as  bathed  and  the  vulvar  dressing  ap- 
plied, is  covered  up  in  bed,  as  a  physiological  chill  occurs 
in  a  large  percentage  of  women  at  this  time. 

The  nurse  should  sit  by  the  bedside  and  hold  the 
fundus  of  the  uterus  for  at  least  an  hour  after  delivery, 
to  guard  against  postpartum  hemorrhage.  A  contracted 
and  empty  uterus  can  not  bleed  to  any  dangerous  ex- 
tent. Temperature,  pulse,  and  respiration  are  taken 
and  recorded  at  this  time,  and  a  note  made  of  the  amount 
and  color  of  the  lochia. 

The  mother  after  this  should  be  watched  carefully, 
pulse  taken  occasionally,  fundus  felt,  and  water  or  very 
light  nourishment  given,  while  the  room  is  being  straight- 
ened up  and  the  soiled  things  disposed  of.  An  ab- 
dominal binder  can  then  be  applied  if  the  patient  desires 
it,  or  if  the  physician  so  orders.  These  are  best  made 
of  coarse  cotton  about  half  a  yard  wide  and  long  enough 
to  go  around  the  body  and  overlap.  Enough  large 
safety-pins  must  be  provided  to  pin  this  up  with — at 
least  two  dozen.  If  an  abdominal  binder  is  used,  it  is 
very  convenient  to  pin  the  lochial  pads  to  in  front  and 


Obstetrical  Nursing 


73 


behind,  and  if  not  a  small  girdle  is  provided,  such  as  is 
ordinarily  worn  by  the  patient  during  her  menstruation, 
or  one  like  that  shown.     (Fig.  23.) 


FIG.  22.      HOLDING  THE  FUNDUS  AFTKR  LABOR. 

The  Breasts  and  Nipples. — If  the  breasts  are  large 
and  pendulous  a  breast  binder,  made  after  the  following 
patterns,  will  give  a  great  deal  of  comfort. 

The  breast  and  nipples  of  a  nursing  mother  require 
the  closest  attention  throughout  lactation,  but  especially 
during  the  first  few  days,  when  the  breasts  are  liable  to 
become  engorged  and  painful,  and  the  nipples  to  become 
macerated,  cracked,  and  fissured.  The  first  important 
rule  to  establish  is  that  the  infant  shall  never  be  allowed 


74 


Obstetrical  Nursing 


to  lie  with  the  nipple  in  its  mouth  after  it  has  finished 
nursing,  which  generally  takes  about  fifteen  minutes. 
This  softens  and  macerates  the  nipple,  and  fissures  soon 
develop.  The  nipple  should  be  washed  with  boracic 
acid  solution  before  and  after  each  nursing;  kept 
thoroughly  dry  between  nursings,  and  protected  with  a 
clean  soft  cloth  over  them.     If  the  milk  oozes  from  the 


3fe  in 


3  in 


3  in, 


4- in    3a 


FIG.  23.      BREAST  BINDER  PATTERN    (COOKE). 


breasts  the  cloth  over  the  nipples  will  need  to  be  changed 
frequently. 

If  the  nipple  becomes  very  tender  a  nipple  shield 
should  be  used  before  a  crack  or  fissure  results.  Most 
babies  take  the  shield  without  trouble.  The  only  prac- 
tical one  is  the  glass  shield,  on  which  is  a  small  rubber 
nipple  and  ivory  disc  to  prevent  the  child  taking  all  the 
nipple  in  its  mouth. 

A  crack  soon  results  in  a  fissure,  than  which  nothing 
is  more  painful  in  the  puerperium.  Nursing  may  be 
so  painful  as  to  cause  the  mother  to  dread  and  shrink 
from  nursing  whenever  it  is  due.  The  fissures  may  be 
upon  the  apex  of  the  nipples  or  at  the  base ;  may  be  very 


Obstetrical  Nursing  75 

small,  or  involve  almost  the  whole  area.  There  are 
several  kinds  of  nipples,  as  shown  in  the  accompanying 
illustration. 

The  depressed  or  flat  nipples  give  the  greatest  trouble. 
If  a  fissure  develops,  the  child  should  not  be  allowed  to 
nurse  from  the  breast  without  a  shield.  If  nursing  is 
very  painful,  the  application  of  cocaine  (3  per  cent 
aqueous  solution)  just  before  the  nursing  will  very  often 


FIG.  24.      GLASS  NIPPLE  SHIELD. 

make  it  much  less  so.  This  should  be  carefully  washed 
off  before  the  child  is  put  to  the  breast.  Immediately 
after  the  nursing  a  4  per  cent  solution  of  nitrate  of  silver 
is  painted  in  the  crack,  which  is  held  open.  This,  with 
the  albumen  of  the  blood,  forms  a  pellicle  over  the  sur- 
face and  helps  it  to  heal  from  the  bottom.  The  nipple 
is  then  dried,  powdered  with  boracic  acid,  starch  or 
talcum,  the  child  nursing  from  the  nipple  shield  until  the 
nipple  is  entirely  healed. 

Women  who  have  large  pendulous  breasts  frequently 
have  much  pain  when  the  milk  first  comes,  unless  a  breast 
binder  is  applied  to  insure  its  even  distribution  through- 
out the  breasts ;  otherwise  it  will  accumulate  in  the  most 


76 


Obstetrical  Nursing 


dependent  portion,  forming  a  "cake"  or  "weed,"  which 
is  very  painful.  The  binder  is  pinned  up  snugly  after 
each  nursing. 


FIG.  25.      BREAST  BINDER. 

The  milk  generally  appears  on  the  evening  of  the 
second  or  some  time  during  the  third  day.  Judicious 
massage,  rubbing  from  the  periphery  toward  the  nipple 
with  a  gentle  stroking  motion,  distributes  the  milk  and 
presses  some  from  the  breast,  giving  great  relief.  Cocoa 
butter  can  be  used  as  an  unguent.  Should  this  not  be 
successful  in  relieving  the  engorgement,  and  if  the  child 
can  not  nurse  it  out,  a  breast  pump  can  be  used.  The 
one  with  the  rubber  tube  for  suction  by  the  mother  or 
nurse  gives  less  pain  and  discomfort  than  the  other 
varieties. 


Obstetrical  Nursing 


11 


Galactagogues. — The  remedies  sometimes  given  to 
increase  the  now  of  milk  are  called  galactagogues. 
Somatose  is  useful,  given  in  teaspoonful  doses  three 
times  a  day ;  malt  liquors  and  malt  extracts  in  moderate 
doses  act  well  with  some  patients,  mostly  by  increasing 


FIG.  26.      BREAST  AND  ABDOMINAL  BINDER. 


the  appetite  and  aiding  assimilation;  tea  increases  the 
quantity,  but  if  taken  in  excess  impairs  the  quality  of  the 
flow.  Cow's  milk  is  an  excellent  milk-maker,  and  should 
form  the  larger  part  of  a  nursing  mother's  diet.  If  she 
can  not  drink  milk  it  can  be  taken  in  the  form  of  cocoa 
or  chocolate  with  each  meal.  A  liberal  general  diet, 
plenty  of  fluids,  and  moderate  exercise  give  the  best 
results. 


78 


Obstetrical  Nursing 


Only  in  a  general  way  should  the  nurse  question  the 
patient  regarding  her  appetite,  never  asking  her  what 
she  wishes  to  eat.     An  invalid  or  one  confined  to  bed 


FIG.    27.      BREAST   PUMP   WITH   MOUTH    SUCTION. 


FIG.  28.      ENGLISH  BREAST  PUMP. 

will  always  eat  more  liberally  if  her  meals  are  brought 

to  her  served  in  tempting  manner,  than  if  she  has  been 

personally  consulted  and  knows  what  food  she  is  to  have. 

The  nurse's  training  should  have  included  a  course 


Obstetrical  Nursing  79 

in  a  diet  kitchen,  and  this  knowledge  is  of  great  practi- 
cal value  in  caring  for  a  lying-in  woman.  She  will  go 
to  the  kitchen  and  personally  prepare  her  patient's  tray, 
seeing  to  it  that  all  dishes  intended  to  be  hot  are  not 
brought  in  cold  or  lukewarm. 

Diet. — The  diet  of  the  mother  is  most  important, 
and  should  be  regulated  carefully.  The  following  diet- 
ary is  suggested  as  a  guide.  It  is  not  meant  to  be  fol- 
lowed as  an  invariable  rule,  as  individual  likes  and  dis- 
likes must  be  considered.  It  is  a  fact,  however,  that 
a  too  liberal  diet,  because  of  the  recumbent  position, 
sluggish  bowels,  etc.,  results  in  a  fermentation  or  de- 
composition of  the  food  in  the  intestinal  tract,  absorp- 
tion of  these  products  causing  an  intestinal  auto- 
intoxication. This  causes  a  temperature,  headache, 
great  intestinal  distention  and  discomfort. 

DIETARY. 

One  or  two  hours  after  labor — 

Either  a  glass  of  milk  or  cup  of  cocoa  or  chocolate 

and  wafer;  cup  of  broth;  cup  of  tea  and  slice  of 

toast. 
First  day — 

Breakfast :     Cereal  and  milk,  or  soft  boiled  egg  with 

dry  or  milk  toast,  tea  or  coffee. 
Lunch :     Clear  soup  or  broth,  crackers  ;  baked  potato. 
Supper:     Boiled  rice  with  cream;  baked  or  steamed 

custard;  milk. 
Second  day — 

Breakfast:     Egg,    soft    boiled    or    poached;    tea    or 

coffee ;  milk ;  toast  or  bread  and  butter. 
Lunch :     Soup  ;  rice ;  milk ;  toast. 
Supper:     Baked    potato;    milk    toast;    bread    and 

butter. 


80  Obstetrical  Nursing 

Third  day — 

Breakfast:  Cereal;  sweetbreads  or  bacon;  egg; 
bread. 

Dinner:  Soup;  oysters  (raw  or  stewed)  or  baked 
fish;  potato;  milk;  bread;  light  pudding  or  jelly. 

Supper :     Cocoa  or  chocolate ;  rice ;  milk. 
Fourth  day — 

Breakfast :  Beefsteak  or  chicken,  once ;  fruit 
(preferably  cooked)  ;  egg;  potato;  cereals;  coffee, 
tea,  or  milk. 

As  a  general  rule  it  may  be  stated  that  the  diet  which 
causes  no  discomfort  in  the  mother  will  not  change  the 
character  of  the  milk  to  cause  it  to  disagree  with  the 
child.  It  is  well,  however,  for  the  nursing  mother  to 
avoid  acids  and  too  free  use  of  condiments  in  her  diet. 

Bowels. — The  bowels  of  the  mother  generally  do  not 
act  until  a  purgative  is  administered  on  the  second  or 
third  day.  The  principal  reason  for  this  is  because  of 
the  lack  of  abdominal  pressure,  due  to  the  relaxed 
abdominal  walls  and  empty  uterus.  The  time-honored 
dose  of  castor  oil  on  the  third  day  is  a  most  excellent 
remedy.  It  can  be  administered  in  orange  juice,  whisky, 
beer,  salt  placed  on  the  tongue,  or  given  without  any- 
thing to  disguise  its  taste.  The  oil  can  be  omitted, 
getting  the  effect  desired  by  the  administration  of 
cascara  sagrada  on  the  evening  of  the  first  and  second 
days  after  the  baby  comes,  assisting  the  bowels  by  the 
administration  of  an  enema  on  the  morning  of  the  third 
day. 

The  question  of  the  effect  certain  remedies  given  the 
mother  may  have  on  the  child  through  the  breast  is 
rather  an  unsettled  one,  but  a  few  drugs  are  believed  to 
have  more  effect  than  others,  notably  the  minerals  and 
rhubarb.  Salts  should  not  be  given  as  a  purgative,  as 
this  decidedly  lessens  the  quantity  of  milk. 


Obstetrical  Nursing 


81 


Bladder. — Owing  to  the  bruised  condition  of  the 
urethra  and  vulva  and  the  swelling  which  results  from 
it,  the  lack  of  pressure  in  the  abdomen   (allowing  the 


FIG.  29.      CATHETERIZATION — FIRST  STEP. 

bladder  to  easily  distend),  and  the  horizontal  position, 
voluntary  urination  is  often  impossible. 

The  urine  should  be  voided  every  eight  hours  at 
least,  and  if  the  patient  is  unable  to  do  so  upon  the 
bed-pan,  unaided,  and  can  not  get  up,  the  application 
of  hot  cloths  over  the   abdomen  in  the   region   of  the 


82 


Obstetrical  Nursing 


bladder,  allowing  warm  water  to  trickle  down  over  the 
vulva,  or  a  warm  enema,  will  frequently  start  it.     If 


FIG.   30.      CATHETERIZATION — SECOND  STEP. 


this    is    unsuccessful    she    must    be    catheterized.      The 
amount  of  urine  passed  each  time  should  be  measured 


Obstetrical  Nursing 


83 


if  possible  and  recorded  on  the  chart.  During  the  first 
few  days  the  urine  when  passed  is  normally  colored  red 
by  the  lochia. 

Catheterization. — This  must  be  done  most  carefully, 


FIG.  31.      GIvASS  CATHETER. 

because  of  the  danger  of  carrying  foreign  material  into 
the  bladder  on  the  catheter.  The  labia  are  separated 
with  the  thumb  and  index  finger  of  the  left  hand,  the 
meatus  located  and  wiped  off  with  a  cotton  swab  wrung 
out  of  a  saturated  solution  of  boracic  acid,  the  catheter 
removed  from  the  boric  acid  solution  and  passed 
directly  into  the  urethra.  A  glass  catheter  is  best  used 
for  this  purpose,  on  the  free  end  of  which  is  placed  a 
short  piece  of  rubber  tubing  to  prevent  the  trickling  of 
the  last  drop  of  urine  on  the  vulva.  Glass  catheters 
are  more  easily  rendered  and  kept  sterile  than  any  other 
material,  are  cheap,  and  easily  replaced  if  broken. 


FIG.  32.      DOUCHE  PAN. 

If  a  primary  perineorrhaphy  has  been  done  it  is  well 
to  catheterize  for  the  first  twenty-four  hours  at  least. 

We  again  emphasize  the  importance  of  locating  the 
urethra  by  sight  and  never  attempting  to  locate  it  by 


84  Obstetrical  Nursing 

the  sense  of  touch  under  the  bed-clothes.  The  swelling 
and  turgescence  due  to  the  labor  displaces  the  meatus 
and  it  can  not  be  located  by  the  ordinary  landmarks,  and 
even  if  it  could  be,  because  of  the  danger  of  causing  a 
cystitis  by  carrying  foreign  matter  into  the  bladder  if 
anything  but  the  urethra  is  touched  by  the  catheter,  it 
is  wise  to  catheterize  by  sight.  A  little  tact  will  gener- 
ally suffice  to  overcome  the  objections  of  a  patient  who 
may  have  been  used  to  the  old  methods  of  catheteriza- 
tion. 

The   Vulva. — The   vulva   is   generally   considerably 
swollen  and  quite  tender  after  labor,  and  the  application 


FIG.  33.      GLASS  DOUCHE   POINT. 

of  cloths  wrung  out  of  a  hot  antiseptic  solution  gives 
great  relief.  If  this  is  not  required  the  parts  are  irri- 
gated externally  with  a  warm  antiseptic  solution  before 
applying  a  sterile  lochial  pad.  No  douche  is  given  under 
any  circumstances  without  explicit  directions  from  the 
attending  physician. 

After  urination  or  a  movement  from  the  bowels  the 
vulva  is  cleansed  by  pouring  over  it  from  a  pitcher 
a  warm  solution  of  lysol,  1  per  cent,  cleansing  the  anus 
and  wiping  away  from  the  vulva,  drying  carefully  with 
sterile  gauze  and  applying  a  fresh  sterile  lochial  pad. 

Special  attention  is  necessary  when  a  primary  perin- 
eorrhaphy is  done.  If  catgut  has  been  used  the  ends  are 
usually  short;  if  silkworm  gut  they  are  left  longer,  as 
the  short  ends  prick  the  vulva  or  thighs  and  are  very 
uncomfortable.  If  too  long  they  may  be  pulled  when 
the  bed-  or  douche-pan  is  pushed  under  the  patient. 


Obstetrical  Nursing  85 

If  there  has  been  a  complete  tear  of  the  perineum 
and  a  primary  perineorrhaphy,  extra  precautions  are 
needed.  Instructions  should  be  asked  of  the  attendant 
physician  regarding  catheterization,  the  bowels,  diet, 
etc.  The  prior  administration  of  an  oil  enema  through 
a  soft  catheter  introduced  into  the  rectum  will  often  aid 
greatly  in  the  evacuation  of  the  bowels. 

Vaginal  Injections  should  never  be  administered 
without  specific  instructions  from  the  physician.  The 
vaginal  injection  is  best  given  with  patient  on  a  douche- 
pan  instead  of  a  bed-pan,  the  latter  holding  such  a  small 


FIG.  34.      INTRA-UTERINE    DOUCHE  POINT. 

quantity  of  fluid.  The  douche  point  is  first  boiled  for 
fifteen  minutes  and  a  new  fountain  syringe  used,  or 
one  whose  history  the  physician  himself  knows.  The 
fountain  syringe  found  in  the  ordinary  home  is  always 
dirty  and  full  of  dust,  hanging  as  it  generally  does  in 
the  bath-room  behind  the  door.  If  a  new  one  is  used, 
care  should  be  taken  to  rinse  it  thoroughly,  in  order  to 
remove  the  white  powder  with  which  new  rubber  is 
covered.  Never  use  a  bulb  syringe  for  administering 
a  douche ;  its  valves  can  not  possibly  be  rendered  sterile. 
Intra-uterine  Injection. — An  intra-uterine  injection 
after  delivery  is  but  seldom  indicated  and  generally  is 
given  by  the  physician  himself,  and  if  by  the  nurse, 
under  the  physician's  directions.  Intra-uterine  injec- 
tions may  cause  a  great  deal  of  pain  and  are  frequently 


86  Obstetrical  Nursing 

the  cause  of  colic,  and  should  be  cautiously  adminis- 
tered. When  given,  the  irrigator  is  raised  not  more  than 
twenty-four  inches  above  the  patient,  and  when  the 
douche  point  is  introduced  one  hand  of  the  nurse  holds 
the  fundus  of  the  uterus,  in  order  to  do  no  violence  to 
that  organ.  The  curved  glass  douche  point  is  best  be- 
cause it  is  more  readily  cleaned,  and  has  a  large  point 
which  can  not  be  easily  forced  through  the  softened 
uterine  wall. 

Bedside  Notes. — A  nurse  should  keep  a  careful 
record  of  all  the  findings  and  happenings  to  a  lying-in 
woman  upon  her  bedside  notes.  These  include  a  record 
of  the  pulse,  respiration,  and  temperature  at  least  twice 
a  day — better  three  times  a  day ;  bowels  and  kidneys ; 
lochia,  color  and  amount ;  after-pains ;  clots  from  vagina ; 
breasts,  milk,  diet,  etc.  The  chart  is  made  up  of  a  short 
resume  of  the  labor,  time  of  stages,  sex  and  weight  of 
child,  etc.  A  separate  chart  must  be  kept  for  the  child, 
recording  its  temperature,  weight,  evacuations,  urine, 
etc. 

Rest. — The  patient  after  her  trying  ordeal  is  in  need 
of  rest,  and  as  soon  as  she  has  been  cleansed  and  the 
protecting  vulvar  pad  applied,  the  bed  changed,  a  clean 
gown  put  on  if  needed,  and  all  evidences  of  the  labor 
removed,  she  should  be  allowed  to  rest  and  sleep,  if 
that  be  possible.  A  close  watch  is  kept  over  her,  to 
guard  against  postpartum  hemorrhage  or  other  com- 
plications. 

Above  all  is  it  essential  that  she  see  no  company 
during  the  early  days  of  the  puerperium,  and  this  rule 
can  not  be  too  strictly  enforced.  Her  position  should 
be  upon  her  back  for  the  first  twenty-four  hours,  but 
after  that  time  there  generally  is  no  contraindication  to 
her  turning  for  a  short  time  upon  either  side,  lying  as 


Obstetrical  Nursing 


87 


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88  Obstetrical  Nursing 

long  upon  one  side  as  the  other.  The  uterus  is  large 
and  heavy,  and  gravitates  to  the  side  upon  which  she 
lies. 

Duration  of  the  Lying-in. — The  duration  of  the 
lying-in  period  or  the  puerperium  depends  mainly 
upon  the  individual.  The  average  time  is  ten  days,  but 
if  complications  have  occurred  in  the  labor,  or  shortly 
after,  this  should  be  prolonged.  The  uterus  during  this 
time  is  contracting,  the  process  by  which  it  finally 
attains  a  size  but  little  larger  than  before  impregnation 
being  called  involution.  When  it  has  reached  the  brim 
of  the  pelvis,  the  fundus  being  no  longer  felt  above  the 
symphysis  pubis,  it  is  generally  safe  for  the  patient  to 
assume  the  upright  position. 

The  getting  up  should  consume  several  days;  at 
first  an  extra  pillow,  then  the  head-rest,  then  the  chair, 
and  in  a  day  or  so  the  first  steps.  When  the  first  steps 
are  taken  most  women  complain  of  a  pricking  sensation 
in  the  feet,  and  often  of  the  feeling  as  if  all  the  pelvic 
organs  would  come  away.  The  latter  is  due  to  a  relax- 
ation of  the  pelvic  floor,  and  can  be  largely  alleviated 
by  wearing  a  wide  napkin  very  snugly  applied  to  the 
vulva.  This  support  gives  the  greatest  relief  and  com- 
fort. 

Not  infrequently,  as  a  result  of  too  much  exertion 
after  getting  up,  the  lochia  alba  becomes  tinged,  and 
this  is  an  indication  always  that  too  much  has  been 
done.     Rest  should  be  insisted  upon  if  this  occurs. 

Menstruation  as  a  rule  does  not  return  until  from 
the  fifth  to  the  seventh  month  after  labor,  if  the  child 
nurses;  if  it  is  not  nursed  it  usually  reappears  about 
the  sixth  week. 

After-pains. — A  woman  after  the  birth  of  her  first 
child  has  very  few  uterine  contractions  which  are  pain- 


Obstetrical  Nursing  89 

ful.  When  present  they  are  called  after-pains.  They 
are  more  painful  in  multiparas.  They  may  be  very 
severe,  and  when  so  are  generally  relieved  by  gentle 
rubbing  over  the  uterus,  with  slight  pressure  in  the 
curve  of  Cams,  which  dislodges  the  blood-clot  the 
uterus  has  been  trying  to  expel,  this  effort  being  the 
cause  of  the  pain.  With  each  child  the  after-pains  are 
more  severe,  requiring  some  anodyne  frequently  for 
their  relief.  These  pains  are  always  more  severe  when 
the  child  is  put  to  the  breast. 


CHAPTER  VI. 
The  Child. 

A  newborn  infant  is  an  object  for  special  study.  It 
should  not  be  looked  on  as  a  miniature  adult,  as  it 
possesses  characteristics  entirely  peculiar  to  itself,  not 
seen  in  later  years  of  its  life. 

The  Head. — The  infant's  head  at  birth  is  misshapen, 
usually  elongated,  this  being  possible  because  the  bones 


FIG.  36.      FETAL  SKUUv. 

are  not  united,  thus  allowing  a  molding  so  as  to 
conform  to  the  shape  of  the  pelvis  as  it  passes  through. 
The  open  spaces  between  the  bones  of  the  skull  are 
called  sutures,  of  which  there  are  four.  The  lambdoid 
suture  separates  the  two  parietal  bones  from  the  occipi- 


Obstetrical  Nursing  91 

tal  bone;  the  sagittal  separates  the  two  parietals;  the 
coronal  is  between  the  two  halves  of  the  frontal  bone 
and  the  two  parietals ;  the  frontal  between  the  two  halves 
of  the  frontal  bone.  Where  these  sutures  coalesce  the 
area  is  called  fontanelle,  so  named  because  the  brain 
seems  to  rise  and  fall  like  a  little  fountain.  There  are 
two  fontanelles,  the  anterior  and  posterior.  The  pos- 
terior is  smaller,  and  is  triangular  in  shape,  having 
three  branches  of  sutures  running  into  it;  the  anterior 
is  quadrilateral  in  shape,  larger,  and  has  four  sutures 
running  into  it.  The  posterior  fontanelle  closes  between 
the  seventh  and  the  ninth  months,  the  anterior  about 
the  end  of  the  second  year.  These  fontanelles  are  of 
importance  as  landmarks  to  the  obstetrician,  as  they 
tell  the  position  of  the  child's  head. 

Fetal  Circulation. — The  blood  comes  from  the  pla- 
centa through  the  umbilical  vein,  and  enters  the  abdo- 
men through  the  umbilicus  or  navel;  a  considerable 
portion  goes  to  the  liver,  and  because  this  organ  gets 
the  first  taste  of  arterial  blood  it  is  the  largest  in  the 
body.  The  blood  in  the  liver  reaches  the  portal  circula- 
tion through  the  hepatic  veins;  the  other  blood  from 
the  placenta  goes  direct  to  the  ascending  vena  cava 
through  the  ductus  venosus.  From  thence  it  goes  into 
the  right  auricle  of  the  heart.  After  birth  this  blood 
goes  into  the  right  ventricle  and  then  into  the  lungs 
to  be  aerated,  but  the  lungs  of  the  fetus  being  closed 
no  blood  reaches  them  except  enough  to  nourish  them, 
and  Nature  sends  it  directly  into  the  left  auricle  through 
the  foramen  ovale,  guided  by  the  Eustachian  valve. 
From  the  left  auricle  it  goes  into  the  left  ventricle,  and 
then  into  the  aorta.  From  the  aorta  it  is  distributed  to 
the  head  and  upper  extremities  and  on  through  the 
descending  aorta.     The  blood  from  the  head  and  upper 


92  Obstetrical  Nursing 

extremities  returns  to  the  right  auricle,  then  into  the 
right  ventricle.  Normally  the  blood  in  the  right  ven- 
tricle should  go  to  the  lungs  to  be  aerated,  but  as  the 
lungs  in  the  fetus  are  impervious,  it  goes  directly  through 
the  ductus  arteriosus  to  the  aorta.  From  this  point  on 
we  have  a  mixed  arterial  and  venous  blood.  After  the 
blood  reaches  the  iliac  arteries  two  branches  are  given 
off,  which  run  forward  over  the  summit  of  the  bladder 
and  under  the  abdominal  wall  to  the  navel.  These  are 
the  hypogastric  arteries,  and  when  they  reach  the 
umbilical  cord  are  called  the  umbilical  arteries.  The 
arteries  of  the  cord  carry  the  venous  blood,  the  vein 
carrying  arterial  blood. 

When  the  cord  is  severed  the  hypogastric  arteries 
are  obliterated,  the  lungs  become  pervious,  and  the 
blood  formerly  going  to  the  aorta  through  the  ductus 
arteriosus  now  goes  to  the  lungs  through  the  pulmonary 
arteries,  where  it  is  aerated.  The  foramen  ovale  soon 
closes  and  the  ductus  venosus  also  becomes  impervious. 

Eyes. — As  soon  as  the  child's  first  toilet  is  begun  the 
eyes  are  washed  and  one  drop  of  a  2  per  cent  nitrate 
of  silver  solution  dropped  in  each  eye,  to  prevent  the 
development  of  an  inflammation  of  the  conjunctiva. 
This  is  Crede's  treatment;  it  does  not  cause  any 
trouble,  and  has  been  the  means  of  preventing  thousands 
of  cases  of  ophthalmia  neonatorum.  The  nitrate  of 
silver  is  followed  at  once  with  some  warm  normal  salt 
solution,  which  is  squeezed  into  the  eyes  to  neutralize 
any  excess  of  the  silver.  The  first  evidence  of  swelling 
of  the  lids,  or  the  presence  of  the  smallest  amount  of 
secretion  gluing  the  lids  together  in  the  morning,  should 
be  reported  at  once  to  the  physician,  not  waiting  for 
his  regular  visit.  The  statistics  of  the  blind  asylums  all 
over  the  country  show  an  alarming  proportion  of  blind- 


RIGHT 
AURICLE 


4" 


FIG.  37.      FETAL  CIRCULATION  (A.  T.  B.  OBSTETRICS). 


94  Obstetrical  Nursing 

ness  of  their  inmates  caused  by  ophthalmia,  and  any 
method  of  treatment  which  will  prevent  it  should  be 
used.  If  it  is  not  used  and  an  ophthalmia  develops,  it 
evidences  itself  by  a  slight  puffiness  about  the  upper 
and  lower  lids  and  secretion  about  the  margins  of  the 
lids,  especially  after  sleeping.  Eversion  of  the  lids 
shows  a  swelling  and  intense  redness  of  the  lid  con- 
junctiva. 

The  danger  to  the  eye  is  not  only  from  the  inflamma- 
tion of  the  conjunctiva,  but  also  from  the  pent-up 
secretions  and  the  swelling  of  the  lids  causing  pressure 
enough  on  the  cornea  to  cause  a  perforation  of  the  eye 
and  the  evacuation  of  the  contents  of  the  chambers.  It 
requires  most  watchful  and  unremitting  care  in  its 
treatment.  The  treatment  consists  in  irrigation  with 
normal  saline  solution  every  two  hours,  the  use  of  cold 
or  hot  applications  to  the  lids,  as  recommended  by  the 
physician,  and  judicious  use  of  the  nitrate  of  silver 
solution  under  his  directions.  To  apply  the  cold  a 
block  of  ice  is  covered  with  squares  of  cloth  large  enough 
to  cover  the  eye,  and  these  are  kept  constantly  on  the 
closed  lids  and  removed  as  they  become  warm,  destroyed 
and  a  fresh  cold  one  applied.  If  only  one  eye  is  affected 
the  other  one  must  be  carefully  protected  against  in- 
fection by  putting  a  watch  crystal  over  the  unaffected 
eye  by  adhesive  plaster  applied  to  the  edges  and  to  the 
skin  around  the  eye. 

A  much  milder  degree  of  inflammation  of  the  con- 
junctiva is  sometimes  encountered,  which  generally 
responds  promptly  to  irrigation  with  saline  solution. 

Umbilical  Cord. — The  umbilical  stump,  cut  about 
two  inches  from  the  abdominal  wall,  is  best  dressed  with 
an  oily  dressing,  as  follows: 

01.   Ricini   oz.     1 

Balsam    Peru    min.  20 


Obstetrical  Nursing  95 

The  balsam  of  Peru  acts  as  an  efficient  antiseptic, 
preventing  sepsis,  which  may  develop  from  absorption 
of  pus-producing  organisms  through  the  navel.  The 
oil  keeps  the  stump  in  a  pliable  condition,  preventing 
it  from  becoming  stiff  and  hard  as  it  separates.  The 
dry  dressings  ordinarily  recommended  make  the  stump 
unusually  difficult  to  care  for.  A  binder  of  very  soft 
flannel  is  applied  snugly,  but  not  tightly,  which  prevents 
the  cord  being  pulled  when  the  child  is  handled.  The 
dressing  is  not  removed  or  touched,  unless  it  is  to  renew 
the  oil  dressing,  until  the  cord  separates.  This  usually 
takes  place  from  the  fourth  to  the  seventh  day,  though 
it  may  remain  attached  for  two  weeks  without  detriment 
to  the  child.  Other  substances  recommended  as  a  cord 
dressing  are  boracic  acid  powder ;  one  part  salicylic  acid, 
three  parts  boracic  acid ;  also  talcum  powder  and  boracic 
acid,  and  alcohol. 

Umbilicus. — When  the  cord  separates  it  should  leave 
a  smooth,  dry,  and  depressed  navel  with  the  skin 
thrown  in  folds,  but  it  sometimes  happens  that  there 
are  left  some  small  vegetations,  which  are  the  ends  of 
the  umbilical  vessels.  These  secrete  a  moisture  which 
dries  on  the  skin,  forming  thin  scabs,  which  are  quite 
irritating.  They  are  best  treated  by  application  of  a 
nitrate  of  silver  solution,  ten  or  twenty  grains  to  the 
ounce,  followed  by  the  balsam  and  oil  dressing  on 
absorbent  gauze. 

If  the  umbilical  stump  is  improperly  cared  for  or 
inadequately  protected  against  infection,  sepsis  may 
occur,  which  manifests  itself  by  fever,  sweating, 
tympanites,  emaciation,  and  perhaps  an  erysipelas- 
like eruption  on  the  skin  of  the  abdomen;  it  generally 
results  fatally.  Hence  it  may  be  seen  how  essential  it 
is  to  dress  the  cord  so  that  infection  can  not  take  place. 


96  Obstetrical  Nursing 

Binder. — No  undue  pressure  should  be  used  in 
applying  the  binder  or  the  waist-bands  of  the  skirt.  The 
binder,  which  is  best  made  of  thin  flannel,  is  used  only 
to  protect  the  cord  from  being  torn  when  the  child  is 
handled,  and  it  is  advised  by  many  authorities  not  to 
reapply  it  after  the  cord  comes  off.  In  winter  a  knitted 
band  can  be  worn  if  it  is  thought  best  to  protect  the 
bowel.  It  is  our  belief  that  all  the  protection  needed 
by  the  bowels  can  be  obtained  with  a  shirt  and  the 
knitted  band. 

Bathing. — The  child  is  allowed  to  remain  undis- 
turbed, except  for  an  occasional  inspection  of  the  cord 
for  hemorrhage,  until  some  hours  after  birth,  when  it 
is  given  its  first  bath.  A  child  should  not  be  bathed  at 
once,  because  of  the  danger  of  chilling ;  the  temperature 
of  the  uterus  is  98.5°  F.  to  99°  F.,  and  the  temperature 
of  the  room  generally  not  more  than  80°  F.,  hence  the 
need  of  protection  from  exposure. 

The  baths,  until  the  cord  is  separated,  should  be 
before  the  fire  on  the  nurse's  lap,  the  tub  or  basin  being 
used  for  full  bath  after  the  cord  drops  off.  When  the 
bath  is  given,  everything  needed  must  be  at  hand  before 
it  is  begun:  a  change  of  clothing,  vaseline,  talcum  pow- 
der, cotton  applicators,  gauze  wash-cloth,  towels,  boracic 
acid  solution,  and  cotton.  A  double  blanket  or  outing 
flannel  apron  will  be  found  of  service  in  bathing  the 
baby,  one  fold  to  protect  the  nurse's  lap,  the  other  to 
cover  the  parts  of  the  child  not  being  bathed.  The 
child  should  first  be  again  thoroughly  anointed  with 
vaseline,  and  this  rubbed  off  with  a  very  soft  cloth  before 
any  soap  and  water  is  applied.  Extra  care  is  needed  for 
the  cleansing  of  the  flexures,  under  the  arms  and  knees, 
elbows  and  groin,  where  the  vernix  is  apt  to  be  especi- 
ally thick.  The  child  may  be  put  in  the  tub  for  its  first 
bath,  though  this  is  not  advised. 


Obstetrical  Nursing 


97 


Not  infrequently 
develops  an  eruption 
close  inspection  shows 
slight  area  of  redness 
white  point.  This  is 
clogging  of  the  sweat  g 
caused  by  the   child 


during  the  first  month  a  child 
over  the  whole  body,  which  on 
a  minute  red  papule  with  a  very 
at  its  base,  surmounted  by  a  fine 
called  sudamina,  and  is  due  to  a 
glands  of  the  skin,  and  is  generally 
being   overheated.      Tepid   baths, 


FIG.  38.      COI.I.APSIBI.E  BATH  TUB. 

followed  by   a   thorough   dusting   with   talcum   powder 
over  the  whole  body,  generally  cures  it  in  a  few  days. 

The  Bowels. — The  first  discharge  from  the  bowel  is 
a  black,  tarry-like  substance  called  meconium,  and  it 
irritates  the  skin  very  much  if  allowed  to  remain  long 
in  contact  with  it.  A  soft  cloth  in  a  bowl  of  warm 
water,  without  soap,  should  be  kept  convenient,  with 
which  the  meconium  can  be  removed  whenever  the  parts 
are  soiled.  The  movements  by  the  end  of  the  first  week 
have  generally  turned  yellow,  losing  their  black  color 


98  Obstetrical  Nursing 

gradually.  They  should  be  entirely  smooth  in  con- 
sistency and  without  the  presence  of  curds  or  mucus; 
if  either  of  these  substances  are  found  they  should  be 
reported  to  the  physician.  The  child  generally  has  from 
four  to  ten  movements  in  twenty-four  hours  the  first 
week. 

When  the  bowels  are  too  free — the  movements  con- 
taining curds  and  mucus — a  dose  of  castor  oil,  fifteen  to 
twenty  drops,  will  clear  up  the  condition.  An  occasional 
warm  saline  enema  is  an  excellent  procedure.  This  is 
best  given  with  a  one-  or  two-ounce  piston  syringe,  upon 
the  end  of  which  is  attached  about  half  of  a  small  soft 
rubber  catheter. 

The  child  is  laid  on  its  side  across  the  nurse's  lap, 
its  buttocks  resting  on  a  piece  of  rubber  sheeting  with  a 
folded  napkin  between,  the  lower  end  of  the  rubber 
draining  into  a  basin  or  slop  jar.  The  child  should  not 
be  exposed  unnecessarily  and  the  operation  too  much 
prolonged. 

As  soon  as  the  child's  bowels  move,  the  napkin  is 
removed,  and  the  skin  washed  with  a  soft  cloth  wet  with 
warm  water  without  soap,  thoroughly  dried,  then  pow- 
dered with  talcum  powder.  If  the  napkin  is  only  wet, 
the  skin  can  be  powdered  without  washing.  If  these 
precautions  are  neglected,  the  skin  of  the  buttocks  and 
thighs  becomes  macerated  and  red,  a  condition  called 
intertrigo.  When  present  it  is  indicative  of  carelessness 
and  neglect ;  in  this  condition  the  use  of  olive  oil  to 
cleanse  the  buttocks  after  an  action  is  preferable  to 
water.  After  the  cleansing  the  stearate  of  zinc  to  this 
kind  of  skin  is  a  valuable  protective  agent.  It  is  dusted 
on  in  the  same  way  talcum  powder  is  used. 

Young  infants  are  especially  prone  to  constipation, 
this  being  largely  due  to  the  anatomical  arrangement  of 


Obstetrical  Nursing  99 

the  large  bowel.  The  sigmoid  flexure  is  much  longer  in 
proportion  to  the  rest  of  the  bowel  at  this  age  than  later, 
and  has  a  longer  mesentery.  The  colon  as  it  grows  does 
so  at  the  expense  of  the  sigmoid.  This  makes  it  difficult 
for  the  child  to  have  a  movement  unaided,  and  injections 
and  suppositories  are  resorted  to  without  detriment  to 
obtain  regular  evacuations.  The  child  should  be  care- 
fully regulated  as  to  habits  of  evacuation  of  the  bowel 
by  placing  it  upon  a  chair  or  vessel  at  the  same  hour 
each  day  as  soon  as  it  is  old  enough,  and  if  an  enema  has 
to  be  given  it  should  be  administered  at  this  time. 

If  a  child  passes  nothing  from  the  bowel  for  twenty- 
four  hours  after  it  is  born  it  should  be  carefully  exam- 
ined to  ascertain  if  it  has  an  imperforate  anus.  If  this 
exists  it  calls  for  immediate  surgical  intervention. 

Urine. — The  urine  under  normal  conditions  makes 
no  stain,  but  contains  a  good  many  irritating  substances, 
which  if  left  in  the  napkin  should  never  be  allowed  to 
dry  on  the  infant  after  being  wet,  but  should  be  care- 
fully washed  and  laundered  before  again  using.  Too 
much  stress  can  not  be  laid  on  the  importance  of  careful 
washing  of  the  baby's  napkins  whenever  soiled  with 
urine  or  with  a  movement  from  the  bowels.  The  old 
idea  that  a  napkin  should  be  dried  three  times  before 
being  washed,  when  carried  out,  has  resulted  in  eczema, 
intertrigo,  and  other  troublesome  skin  lesions.  Napkins 
should  be  boiled  after  every  soiling  before  using  again. 

A  child  should  be  given  water  frequently  during  the 
day,  either  through  a  nipple,  from  a  bottle  with  nipple 
attached,  or  from  a  spoon.  This  is  far  too  often  neg- 
lected. Just  after  birth  this  is  especially  important, 
because  of  the  necessity  of  a  thorough  flushing  of  the 
kidneys  during  the  first  few  days.  There  is  often  much 
pain  caused  by  the  passage  of  very  fine  sandy  particles 


100 


Obstetrical  Nursing 


from  the  kidneys,  which  stain  the  napkin  red  or  brown 
in  color.  These  particles  are  made  up  of  uric  acid,  and 
if  a  large  quantity  of  water  is  taken  it  is  much  easier 
passed  and  gives  less  pain. 


FIG.  39.      STEELYARDS  FOR  FIRST  WEIGHING  OF  BABY. 


Weighing. — The  baby  should  be  weighed  before  its 
clothing  is  put  on,  either  at  the  time  of  the  first  bath 
or  just  after  its  birth.  It  can  not  be  emphasized  too 
forcibly  that  to  note  the  progress  of  a  child  it  is  abso- 


Obstetrical  Nursing 


101 


lutely  essential  that  its  weight  be  known.  This  can  only 
be  done  by  regular  weighings  and  an  accurate  record 
kept  upon  a  chart  like  the  one  shown  in  the  illustration. 
The  only  accurate  method  of  ascertaining  the 
progress  of  a  child  is  by  regular  weighing.     This  is  a 


FIG.  40.      DIAI,  SCALES  WITH  BASKET. 

procedure  generally  neglected.  A  pair  of  scales  or 
steelyards  should  be  a  part  of  every  obstetrician's 
outfit,  as  well  as  in  every  household.  The  child  is 
weighed  once  a  week,  under  exactly  similar  conditions 
as  to  feeding,  time  of  day,  etc.,  and  an  accurate  record 
kept  for  observation.  The  best  scales  for  use  in  the 
home  is  the  grocers'  scales  with  balance  arm  and  weights, 


102 


Obstetrical  Nursing 


but  the  scales  with  platform,  on  which  is  anchored  a 
basket  for  holding  the  infant,  can  be  used  to  advantage 


HAfLrtOCK   and 

SCALES 

ROLLED 


FIG.  4T.      HAMMOCK  AND  SCALES  (COOKE). 

provided  the  child  is  not  too  vigorous  when  in  the  basket. 
The  advantage  of  this  form  of  scales  is  that  by  a  thumb- 
screw on  the  top  the  basket  and  blanket  can  be  weighed 
by  turning  the  pointer  back  to  zero. 


Obstetrical  Nursing  103 

If  weighed  daily  the  child  will  be  found  to  lose  in 
weight  for  the  first  five  days,  but  during  the 
second  week  it  begins  to  gain,  and  at  the  end  of  the 
second  week  should  have  reached  its  birth  weight.  The 
gain  from  this  time  should  be  progressive  and  steady, 
at  the  rate  of  at  least  four  ounces  a  week.  If  it  does 
not  gain  this  amount  the  child  is  not  doing  well. 

The  average  weight  of  a  newborn  infant  is  seven  and 
a  half  pounds,  boys  slightly  heavier  than  girls.  Ten- 
and  twelve-pound  babies  are  extremely  rare.  It  meas- 
ures from  the  crown  of  the  head  to  the  heels  about 
twenty  inches. 

The  child's  head  develops  more  rapidly  than  the 
other  parts  of  the  body  in  its  intra-uterine  growth,  the 
shoulders  measuring  less  in  circumference  than  the  head. 
The  liver  is  the  heaviest  organ  in  the  abdominal  cavity, 
having  received  the  first  supply  of  arterial  blood  from 
the  placenta  after  it  reaches  the  abdomen. 

Sleep. — A  newborn  infant  should  sleep  twenty  hours 
out  of  the  twenty-four,  and  if  not  asleep  lie  in  its  crib 
or  cradle  without  wanting  to  be  taken  up  or  rocked. 
If  it  is  remembered  that  as  a  baby  is  started  in  life,  as 
regards  its  habits,  sleep,  feeding,  etc.,  so  will  it  be  dur- 
ing its  first  year  of  life,  we  would  encounter  fewer  ill- 
behaved  babies.  It  takes  about  two  weeks  to  establish 
a  bad  habit  of  rocking,  walking,  feeding  at  irregular 
intervals,  etc.,  and  a  long  time  to  break  a  child  of  it. 

The  baby  should  be  provided  with  a  crib  or  cradle 
without  rockers,  and  never  be  allowed  to  remain  in  bed 
with  the  mother.  If  in  the  mother's  bed  it  breathes 
the  exhalations  from  the  mother's  skin,  and  is  in  danger 
of  being  overlaid  and  asphyxiated.  A  baby  should  not 
be  held  or  coddled,  but  put  in  its  crib  after  each  feed- 
ing.   Infants  are  creatures  of  habit,  and  can  be  trained 


104  Obstetrical  Nursing 

from  their  birth.  They  should  sleep  twenty  hours  out 
of  every  twenty-four,  and  when  not  asleep  be  neither 
restless  or  crying.  A  baby  does  not  cry  unless  some- 
thing is  the  matter  with  it. 

Cry. — If  a  child  cries  a  great  deal  the  cause  of  it 
should  be  investigated.  The  cry  is  a  language  peculiar 
to  itself,  and  to  the  trained  ear  conveys  a  great  deal  of 
information.  If  it  begins  to  cry  as  soon  as  the  breast 
is  taken  away  from  it,  the  supply  of  milk  is  usually 
insufficient ;  if  very  soon  afterward,  the  quality  is  gener- 
ally below  the  standard  required;  if  it  cries  within  half 
an  hour  afterward,  doubling  up  its  legs  and  arms,  with 
a  tense  abdomen,  the  cause  is  likely  colic.  The  cry  of 
pain  is  different  from  that  of  hunger;  if  sharp  and 
shrill,  with  short  intervals  of  quiet,  there  is  probably 
some  inflammatory  trouble  somewhere ;  if  accompanied 
with  hurried  and  shallow  breathing,  with  an  expiratory 
grunt  occasionally,  some  pulmonary  inflammation  is 
likely  to  be  found. 

What  is  known  as  "three  months'  colic"  by  the  laity 
is  entirely  unnecessary,  for  if  colic  exists  it  can  generally 
be  corrected  by  attention  to  the  mother's  milk.  An 
examination  of  it  will  show  which  of  the  various  ingredi- 
ents may  be  at  fault,  and  an  attempt  should  be  made  to 
correct  the  difficulty.  If  this  is  not  possible  the  child 
should  be  put  on  modified  cow's  milk. 

Respiration. — As  soon  as  the  child  is  born  it  inspires, 
and  after  two  or  three  deep  inspirations  cries.  As 
pointed  out  before,  it  is  very  necessary  at  this  stage  to 
cleanse  the  nose  and  mouth  of  mucus,  to  prevent  its 
aspiration  into  the  lungs.  Frequently  efforts  at  inspira- 
tion are  made  before  the  head  is  born,  this  being  especi- 
ally true  in  breech  presentations.  In  these  cases  the 
body  should  be  enveloped  in  a  warm  towel  to  protect  it 


Obstetrical  Nursing  105 

from  chill,  the  cold  being  a  decided  stimulus  to  respira- 
tion. 

Artificial  Respiration. — When  the  child  does  not 
breathe  well  at  first,  efforts  must  be  made  to  cause  it 
to  inspire,  this  procedure  being  called  artificial  respira- 
tion. A  tub  or  basin  of  water,  at  a  temperature  of 
about  100°  F.,  should  always  be  provided  for  this 
emergency,  the  child  being  put  in  the  warm  water  as 
soon  as  the  cord  is  severed.  This  will  frequently  cause 
it  to  make  an  inspiratory  effort.  A  few  drops  of  cold 
water  on  the  chest  as  its  body  is  held  immersed  in  the 
warm  water  is  a  good  agent  also. 

The  Sylvester  method  consists  in  the  following 
maneuvers:  The  infant  is  placed  upon  its  back  with  a 
folded  towel  under  its  shoulders,  the  head  thrown  back. 
The  operator  stands  at  the  baby's  head;  its  arms  are 
carried  slowly  well  up  over  the  head,  which  elevates 
the  chest  and  causes  it  to  expand,  the  lungs  being  in 
that  way  inflated.  This  is  inspiration.  The  arms  are 
then  carried  slowly  downward  across  the  chest,  slight 
pressure  being  made  on  the  chest,  which  causes  the  air 
in  the  chest  to  be  forced  out,  or  expiration.  These  move- 
ments should  not  be  repeated  oftener  then  fifteen  times 
to  the  minute. 

The  Schultze  method  is  as  follows:  After  tying  the 
cord  the  child  is  held  suspended  by  the  fingers  in  the 
axilla,  back  of  child  toward  the  operator,  his  thumbs 
grasping  the  shoulders.  The  child  is  then  swung  up- 
ward and  toward  the  operator's  face,  the  head  down, 
the  body  doubling  on  itself.  The  weight  of  the  lower 
part  of  the  body  being  thrown  on  the  chest  causes  the 
air  to  be  forced  out  of  the  lungs — expiration;  the  child 
is  then  allowed  to  drop  forward,  the  lower  extremities 
drag  on  the  chest,  causing  it  to  allow  the  entrance  of 


FIG.  42.      SCHUI/TZF,  METHOD  ARTIFICIAL  RESPIRATION 
— FIRST  STEP  (A.  T.  B.  OBSTETRICS). 


Obstetrical  Nursing 


107 


air — inspiration.  These  movements  are  repeated  fifteen 
times  a  minute.  The  advantage  of  the  Sylvester  method 
is  that  it  can  be  done  with  the  child  in  a  warm  bath. 


FIG.  43.      SCHULTZE  METHOD  ARTIFICIAL  RESPIRATION 
— SECOND  STEP  (A.  T.  B.  OBSTETRICS). 

In  the  Byrd-Dew  method  the  child  is  held  upon  its 
back  in  the  open  palms  of  the  operator,  and  a  series  of 
movements   made   which   alternately   doubles   the   child 


108  Obstetrical  Nursing 

on  itself,  thus  compressing  the  lungs,  for  expiration,  and 
extending  the  spine  by  allowing  the  head  to  drop  back- 
ward, for  inspiration. 

The  Laborde  method  is  the  rhythmical  traction  on  the 
tongue,  fifteen  or  twenty  times  a  minute. 

The  sphincter  ani  muscle  may  be  stretched,  also,  as 
one  method  of  reflexly  stimulating  the  respiratory 
centers. 

As  long  as  there  is  a  pulsation  of  the  heart  there  is 
a  possibility  of  finally  causing  respiration.  The  respira- 
tions are  from  30  to  50,  also  more  frequent  when  crying. 
Later,  in  childhood,  respirations  of  50  generally  indicate 
some  pulmonary  disorder.  The  inspirations  are  not 
very  deep,  the  breathing  being  largely  abdominal  and 
frequently  irregular. 

The  Pulse  of  the  newborn  is  quite  rapid,  130  to  150, 
and  remains  so  for  a  number  of  weeks.  It  is  increased 
in  frequency  by  crying.  The  pulse  can  be  counted  by 
feeling  any  of  the  larger  superficial  arteries,  the  radial 
or  temporal  especially. 

The  Temperature  of  a  newborn  child  is  between 
99°  F.  and  100°  F.,  and  its  temperature  should  be 
taken  and  recorded  at  least  twice  daily  for  the  first 
week.  A  phenomenon  frequently  encountered  during 
the  first  five  or  six  days  is  a  rise  of  temperature  of 
several  degrees,  which  is  due  to  starvation,  having  been 
called  starvation  temperature  by  the  author  in  a  paper 
published  simultaneously  with  one  by  Dr.  L.  Emmet 
Holt,  of  New  York,  in  which  he  termed  it  "inanition 
fever. ' ' 

If  a  child  is  restless  and  peevish,  crying  constantly, 
with  a  dry  mouth,  sucking  ravenously  on  anything  put 
in  its  mouth,  even  after  being  put  to  the  breast,  its 
temperature  will  be   found  to  show  a  record  of  from 


Obstetrical  Nursing 


109 


101°  F.  to  103°  F.     The  following  temperature  chart  is 
illustrative  of  this  condition. 


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FIG.  44.      STARVATION  TEMPERATURE. 

If  it  is  given  modified  milk  mixture  it  will  take  it 
ravenously,  and  in  a  short  time  its  temperature  will  have 
dropped  to  normal. 

Mouth. — The  mouth  needs  constant  attention  during 
infancy  to  prevent  the  development  of  thrush  or  sprue, 


110  Obstetrical  Nursing 

which  is  produced  by  an  organism  called  the  saccha- 
romyces  albicans,  milk  being  an  excellent  culture 
medium  for  the  development  of  this  organism.  The 
baby's  mouth  should  be  washed  before  and  after  each 
nursing — before  nursing  for  the  protection  of  the 
mother's  breasts,  and  after  for  the  removal  of  any  milk 
which  may  be  left  in  the  mouth.  With  a  piece  of 
absorbent  cotton  wrapped  around  the  end  of  the  little 
finger,  wet  with  a  saturated  solution  of  boracic  acid, 
the  mouth  is  easily  swabbed  in  all  of  its  crevices.  No 
violence  should  be  used  in  the  washing.  No  harm  results 
if  the  child  sucks  the  cotton  and  swallows  some  of  the 
solution.  Thrush  evidences  itself  by  the  development  of 
fine  white  specks  on  a  reddish  area,  first  on  the  inside 
of  the  cheeks,  on  the  lips,  and  about  the  gums.  These 
are  at  first  isolated,  then  coalesce  unless  treated,  finally 
forming  a  white  covering  to  the  whole  of  the  buccal 
mucous  membrane,  and  possibly  extending  down  the 
esophagus  to  the  stomach. 

Bednars'  Aphthae. — At  the  junction  of  the  hard  and 
soft  palate  there  may  develop  one  or  two  round  ulcers, 
which  are  caused  by  too  vigorous  cleansing  of  the  mouth, 
breaking  the  surface  of  the  mucous  membrane,  the  ulcer 
resulting.     It  interferes  very  much  with  nursing. 

Teeth. — A  child  may  be  born  with  one  or  two  teeth, 
but  this  is  an  exceptionally  rare  occurrence,  and  if 
present  they  should  be  extracted  if  they  are  loose,  be- 
cause of  the  possibility  of  injuring  the  mother's  nipple, 
and  of  being  swallowed  if  detached  while  nursing. 

The  teeth  are  present  in  the  tooth  or  dental  sacs 
located  in  the  gums  at  birth,  and  make  their  appearance 
at  various  times  until  the  twenty  deciduous  or  temporary 
teeth  are  cut.  Fig.  45  illustrates  the  appearance  of  the 
first  teeth. 


Obstetrical  Nursing 


111 


Under    normal    conditions    the    gums    are    red    and 
swollen  when  a  tooth  is  cut,  but  the  phenomenon  may 


CENTRAL 
TNC"lS6ftSi 


ANTERIOR 
MOLAR 

POSTERIOR, 
rid  LARS 


^m 


THIRD 
MOLARS. 


FIG.  45.      DECIDUOUS  OR  MILK  TEETH. 
PERMANENT  TEETH. 

give  rise  to  a  number  of  symptoms.  The  child  is  rest- 
less, saliva  flows  freely  from  the  mouth,  and  it  bites 
upon  everything  that  may  be  at  hand. 

A  child  the  subject  of  malnutrition  or  rickets  cuts 


112  Obstetrical  Nursing 

teeth  very  irregularly  and  much  later  than  a  normal 
well-nourished  child.  Nursing  infants  cut  teeth  much 
sooner  and  easier  than  those  fed  from  the  bottle. 

The  period  from  birth  until  the  first  teeth  have  made 
their  appearance  is  called  infancy;  from  this  period 
until  puberty,  childhood;  and  adolescence  the  rest  of 
life. 

Premature  Children.— A  child  born  before  the  full 
term  of  gestation  is  said  to  be  a  premature  child,  and  it 
is  considered  viable  when  it  is  able  to  exist  independ- 
ently of  the  mother;  if  born  before  the  seventh  month 
it  is  not  considered  viable,  though  some  children  born 
at  this  time  have  developed  with  the  assistance  of  an 
incubator  or  couveuse.  A  premature  child  has  little 
resistance  and  has  to  be  most  carefully  fed,  its  secretions 
and  excretions,  weight,  sleep,  etc.,  being  minutely 
watched.  The  cord  should  not  be  tied  until  all  the 
pulsations  have  ceased  a  few  inches  from  the  navel,  thus 
insuring  the  child's  retaining  in  its  vessels  all  the  blood 
which  would  be  left  in  the  placenta.  It  should  be  laid 
on  its  right  side,  to  insure  the  closure  of  the  foramen 
ovale,  and  wrapped  from  head  to  foot  in  absorbent 
cotton.  In  this  way  it  is  kept  from  draughts  and  its 
body  temperature  is  kept  about  normal.  A  valuable 
aid  to  its  nutrition  is  inunction  with  cod-liver  oil,  or 
the  cotton  may  be  saturated  with  the  oil.  There  is 
certainly  some  absorption  of  fat  in  this  way  through  the 
skin,  which  contributes  to  the  nourishment  of  the  infant. 
These  premature  infants  are  frequently  too  weak  to 
suck  if  put  to  the  breast  or  given  a  bottle,  and  in  this 
case  the  breast  milk  can  be  given  by  means  of  a  medi- 
cine dropper.  If  breast  milk  can  be  obtained  it  will 
generally  nourish  better.  The  first  milk  withdrawn 
should  be  thrown  away,  the  middle  milk  and  strippings 


Obstetrical  Nursing 


113 


being  administered.     If  breast  milk  is  unobtainable  the 
child  may  be  given  modified  milk  of  a  very  weak  per- 


FIG.  46.      TRACING  OF  INFANT'S  STOMACH  (kELLFy). 

centage,  care  being  taken  not  to  give  too  large  a  quan- 
tity at  a  feeding.  The  stomach  of  a  newborn  child  at 
full  term  holds  about  one-half  ounce,   and  that  of  a 


THREE  MONTHS 
4  OUNCES 


SIX  MONTHS 
5*  OUNCES 


FIG.  47.      TRACING  OF  INFANT'S    STOMACH  (KELLEY). 


H 

w 

a 

< 
o 

to 

S5 

M 

o 
o 

u 


CO 

O 


116  Obstetrical  Nursing 

premature  infant  necessarily  less.  Fig.  46  is  a  facsimile 
outline  of  the  stomach  of  a  full-term  infant,  and  illus- 
trates how  easy  it  is  to  overcrowd  it.  It  will  be  seen  that 
the  stomach  at  birth  is  practically  a  dilated  end  of  the 
esophagus,  and  explains  why  the  infant  vomits  or  rather 
regurgitates  the  contents  of  the  stomach  so  easily. 

ABNORMAL  CONDITIONS  IN  INFANCY. 

Deformities. — A  child  must  be  carefully  inspected, 
before  it  is  left  by  the  physician,  as  to  whether  any 
deformities  exist,  among  which  may  be  mentioned 
tongue-tie,  hydrocephalus,  hernia  cerebri,  spina  bifida, 
webbed  fingers  and  toes,  supernumerary  toes  and  fingers, 
club  feet,  hare-lip,  cleft  palate,  imperforate  anus. 

A  tongue-tie  is  caused  by  a  very  short  frenum  of  the 
tongue,  and  when  present  materially  interferes  with 
nursing.  It  can  be  corrected  by  cutting  when  the  child 
is  a  few  days  old. 

Hydrocephalus  is  an  accumulation  of  cerebro-spinal 
fluid  in  the  cavities  of  the  brain,  which  may  distend  the 
skull  to  an  enormous  extent.  A  child  may  live  with 
this  condition  for  a  long  while,  but  never  with  normal 
intellection. 

Hernia  cerebri  is  a  protrusion  of  the  membranes  of 
the  brain  and  some  brain  tissue  through  an  opening  in 
the  skull.  It  may  not  give  rise  to  any  symptoms,  and 
if  held  back  within  the  skull  by  a  properly  fitting  pad 
the  bone  may  grow  enough  to  retain  it  permanently. 

A  spina  bifida  is  a  similar  condition  to  that  just 
described,  only  the  failure  to  close  is  in  the  spinal  col- 
umn, wdth  a  protrusion  of  the  cord  or  the  membranes 
distended  with  fluid  through  this  opening.  It  is  a  surgi- 
cal condition. 

Webbed  fingers  and  toes  and  supernumerary  fingers 


Obstetrical  Nursing  111 

and  toes  are  of  interest  only  as  regards  the  possible  time 
for  their  correction  or  removal  by  appropriate  surgical 
treatment. 

A  cleft  palate  or  hare-lip  may  interfere  materially 
with  the  child's  ability  to  nurse.  The  hare-lip  may  be 
double,  with  a  projecting  mass  of  the  superior  maxilla, 
in  which  may  be  a  tooth,  in  between  the  cleft  in  the 
lip.  The  opening  in  the  palate  may  be  very  slight  in 
extent,  involving  principally  the  soft  structures,  or  it 
may  involve  both  soft  and  hard  palates.  Nothing  can 
be  done  to  a  child  with  these  conditions  except  to  nourish 
it  as  well  as  possible  and  wait  for  several  months  until 
an  operation  looking  to  a  closure  may  be  performed. 
Some  authorities  advise  an  operation  during  the  first 
few  weeks. 

Club  feet  can  be  corrected  to  a  great  degree  by  early 
massage  and  the  application  of  proper  splints  while  the 
tissues  are  soft  and  pliable. 

Imperforate  amis  calls  for  immediate  surgical  inter- 
ference, in  order  to  restore  the  proper  function  of  the 
bowel.  Should  the  child  have  no  passage  from  the  bowel 
during  the  first  twenty-four  hours  it  should  be  examined 
closely  to  ascertain  if  the  anus  is  open,  and  if  not  steps 
taken  at  once  to  open  it. 

If  a  newborn  child  can  not  breathe  through  its  nose, 
or  does  so  with  an  audible  snuffle,  and  this  gets  progres- 
sively worse,  it  is  a  suspicious  symptom  and  should  be 
reported  to  the  physician.  One  of  the  most  frequent 
symptoms  of  inherited  infantile  syphilis  is  persistent 
snuffles,  which  with  a  hoarse  cry,  characteristic  eruption, 
skin  trouble  at  the  anus,  make  the  diagnosis  fairly  cer- 
tain. Inunction  of  a  50  per  cent  mercurial  ointment  in 
lanolin  is  the  best  method  of  treatment.  A  piece  of 
the  ointment  as  large  as  a  good-sized  pea  is  rubbed  in 


118  Obstetrical  Nursing 

one  of  the  flexures  every  night.  Each  night  a  new  site 
is  selected  for  the  inunction,  first  the  popliteal  spaces, 
the  flexures  of  the  elbow,  the  groin,  lower  abdomen,  etc., 
in  this  way  each  site  getting  a  short  rest. 

During  the  first  week  it  is  not  infrequent  to  find  the 
child's  breasts  enlarge  from  a  secretion  of  milk.  It  is 
very  rare  for  them  to  give  much  trouble,  but  they  may 
be  found  to  suppurate,  necessitating  free  incision  and 
drainage.  When  they  fill  up  with  milk  they  should 
be  let  entirely  alone.  If  no  pressure  is  applied  or  any 
lotion  rubbed  upon  them  Nature  will  absorb  the  secre- 
tion without  difficulty. 

At  birth  the  foreskin  of  male  babies  is  long  and 
narrow,  and  for  this  reason,  and  because  there  are  some 
natural  adhesions  between  it  and  the  penis,  it  can  not 
be  retracted.  At  the  end  of  the  first  month  or  so  the 
foreskin  can  be  pushed  back,  in  one  or  two  attempts 
several  days  apart,  the  adhesions  broken  up,  the  accumu- 
lated secretion — called  smegma — removed,  and  the 
mother  instructed  how  to  draw  it  back.  Vaseline  should 
be  applied,  and  the  same  procedure  gone  through  with 
once  a  week  as  part  of  the  child's  toilet.  If  this  is 
done  when  the  child  is  young  it  obviates  the  necessity 
for  a  circumcision  later  in  life,  an  operation  which  would 
never  be  needed  if  these  precautions  were  complied  with. 

Caput. — At  birth  the  child's  head  is  much  out  of 
shape,  due  to  the  molding  it  underwent  in  its  passage 
through  the  canal.  Because  of  the  pressure  on  the 
scalp  a  free  return  of  the  blood  from  the  part  presenting 
is  prevented,  and  there  is  poured  out  in  the  soft  tissues 
of  the  scalp  the  fluid  part  of  the  blood,  which  forms  a 
small  projection  or  tumor  called  the  caput  succedaneum. 
This  tumor  is  formed  in  the  cellular  tissues  by  the 
walrry  parts  of  the  blood;  it  is  present  when  the  child 


Obstetrical  Nursing  119 

is  born  and  disappears  during  the  first  twelve  hours.  It 
may  be  found  on  any  presenting  part. 

Cephalhematoma. — Another  tumor  upon  the  head, 
the  cephalhematoma  (cephal  meaning  head  and  hema- 
toma a  blood  tumor),  is  located  between  the  periosteum 
and  the  bone ;  it  is  composed  entirely  of  blood,  due  to 
rupture  of  capillaries  in  the  periosteum.  It  is  generally 
several  days  in  making  its  appearance  and  continues  to 
enlarge  for  several  days,  disappearing  in  two  or  three 
months.  The  caput  may  be  present  on  any  presenting 
part — face,  vertex,  or  breech ;  the  cephalhematoma  is 
never  found  except  upon  the  head  and  over  one  of  the 
bones,  generally  either  parietal  bone,  or  both. 

Jaundice. — During  the  first  week  of  life  the  child's 
skin  and  conjunctiva  often  turn  yellow  from  the  deposit 
of  biliary  coloring  matter.  This  is  termed  jaundice,  and 
is  present  in  a  large  percentage  of  cases.  It  is  either 
very  mild  or  quite  severe,  and  when  severe  the  child  is 
listless,  sleeping  most  of  the  time,  and  nurses  poorly  if 
at  all.  Its  presence  has  been  variously  explained  as 
entirely  of  liver  origin,  change  in  the  blood  itself,  and 
dependent  on  the  change  in  circulation  of  the  infant. 

Sudamina. — This  vesicular  eruption  has  already 
been  referred  to. 

Colic. — The  formation  of  gas  in  the  bowel  and  its 
rapid  movement  through  coils  of  intestines  causes  pain, 
crying,  drawing  up  of  the  legs  and  thighs,  and  waving 
of  the  arms.  The  pressure  of  the  weight  of  the  hand 
on  the  abdomen  may  cause  some  relief,  and  the  move- 
ment of  the  gas  can  be  felt. 

Errors  in  feeding  or  in  the  quality  of  the  milk  are 
the  principal  causes.  Too  frequent  nursing,  irregu- 
larity, too  rapid  emptying  of  the  breast,  milk  too  rich 
in  proteids,  caused  by  lack  of  exercise  by  the  mother 


120  Obstetrical  Nursing 

and  eating  too  much  meat,  are  causes.  Chilling  of  the 
child  following  nursing  may  cause  it.  It  is  often  the 
case  that  crying  after  nursing  is  due  to  hunger  from  too 
little  milk  and  not  to  colic,  in  which  case  the  stools  arc 
smooth  and  normal  and  show  no  signs  of  indigestion. 

The  treatment  is  varied,  no  two  cases  being  exactly 
similar.  Holding  the  child  on  the  shoulder,  its  wreight 
pressing  on  the  stomach  and  intestines,  dislodges  the 
gas ;  warm  water  containing  a  drop  of  essence  of  pepper- 
mint ;  a  warm  saline  enema ;  heat  applied  to  the  abdomen 
by  allowing  the  child  to  lie  on  a  warm- water  bag.  Under 
no  circumstances  should  whisky,  Dewey's  mixture,  or 
paregoric  or  other  form  of  opium,  be  given. 

Vomiting. — Owing  to  the  shape  of  the  infant's 
stomach  its  contents  are  easily  regurgitated,  especially 
if  the  child  is  handled  after  nursing  or  the  abdomen 
] tressed  upon.  The  amount  regurgitated  usually  appears 
much  greater  than  is  actually  lost.  If  blood  is  vomited 
the  nipple  must  first  be  examined,  and  if  found  fissured 
the  site  of  the  bleeding  is  ascertained,  but  if  the  nipple 
is  normal  it  more  than  likely  comes  from  the  stomach. 
Blood  in  the  matter  vomited  should  be  reported  at  once 
to  the  physician. 

Stools. — The  normal  stool,  after  the  meconium  dis- 
appears, is  a  smooth  homogeneous  mixture,  bright  yellow 
in  color,  and  contains  but  few  or  no  curds  and  very 
little  mucus.  After  the  first  week  they  should  not  be 
more  frequent  than  four  in  the  twenty-four  hours. 
Thin,  frequent,  and  green  stools  are  evidences  of  a 
diarrheal  condition  and  should  be  at  once  reported. 

If  every  napkin  which  is  removed  is  stained  with  a 
spot  of  fecal  matter,  the  condition  is  abnormal,  and  soon 
causes  an  intertrigo.  A  preliminary  dose  of  castor  oil, 
diminishing  the  length   of  nursing  and  increasing  the 


Obstetrical  Nursing  121 

interval,  and  giving  water  after  each  nursing,  will 
usually  correct  this  abnormality.  It  may  be  necessary 
for  the  physician  to  give  bismuth  if  it  is  not  corrected. 


FIG.  49.      INFANT'S  BULB  SYRINGE. 

Cyanosis. — Persistent  blueness  of  the  skin  after 
respiration  is  established  and  the  child  has  cried,  the 
blueness  increasing  when  it  does  cry,  is  due  to  the  fail- 
ure of  the  foramen  ovale  to  close.  This  is  the  opening 
in  the  wall  between  the  auricles,  and  was  necessary  be- 
fore birth,  when  the  lungs  were  not  being  used.  This 
opening,  if  it  persists,  allows  the  venous  blood  coming 
from  the  inferior  and  superior  vena  cava  into  the  right 
auricle  to  escape  into  the  left  auricle,  contaminating  the 


122  Obstetrical  Nursing 

red,  arterial  blood  with  blue,  venous  blood.  Babies 
so  afflicted  are  called  "blue  babies,"  and  they  rarely 
live  to  the  age  of  puberty. 

Menstruation. — Infrequently  in  female  infants,  dur- 
ing the  first  two  or  three  weeks,  a  slight  bloody  vaginal 
discharge  may  be  noticed.  As  a  rule  it  is  very  slight 
and  temporary,  though  it  may  be  very  free. 

Hemorrhages. — A  newborn  infant  is  specially  prone 
to  develop  hemorrhages,  which  are  referred  to  as  lit  m- 
orrhages  of  the  newborn. 

Umbilical  hemorrhage,  or  hemorrhage  from  the  cord, 
may  occur  before  it  drops  off,  either  from  a  loosely 
applied  ligature  or  from  the  vessels  being  cut  through 
by  a  small  ligature  being  tied  too  tightly.  Both  of  these 
accidents  can  be  prevented  by  the  use  of  a  rubber  elas- 
tic ligature,  in  the  form  of  a  small  rubber  ring,  of  cali- 
ber smaller  than  the  circumference  of  the  cord,  which 
is  stretched  and  slipped  over  the  severed  end  of  the 
cord,  by  one  of  the  appliances  for  that  purpose.  A  liga- 
ture of  this  kind  exerts  continuous  pressure  on  the 
vessels  as  the  Wharton's  jelly  dries,  and  bleeding  is 
more  effectually  prevented  than  can  possibly  be  done 
by  any  other  means. 

Hemorrhage  may  occur  from  the  umbilicus  after  the 
cord  has  dropped  off,  and  in  all  such  cases  there  is  a 
tendency  to  hemorrhage,  as  is  found  in  hemophilia  or 
the  "bleeders." 

Pressure  upon  the  bleeding  vessels  at  this  point  is 
very  difficult  to  accomplish.  If  there  is  but  a  sum  11 
amount  oT  oozing,  the  application  of  persulphate  of  iron 
may  control  it.  Needles  carried  under  the  umbilicus 
at  right  angles  and  wrapped  with  a  figure-of-eight 
suture  should  be  tried  in  the  severer  cases. 

The    cause   of   the   hemorrhages   of   the    newborn    is 


Obstetrical  Nursing  12.°) 

obscure.  The  bleeding  may  occur  from  any  organ,  most 
frequently  perhaps  from  the  stomach  and  intestines. 
When  the  blood  is  passed  from  the  intestine  in  the 
movement  the  condition  is  called  melena.  The  treat- 
ment of  this  trouble  is  in  many  cases  of  no  avail.  The 
injection,  subcutaneously,  of  a  thoroughly  sterilized 
solution  of  gelatin  has  given  good  results. 

Granulated  Umbilicus. — After  the  separation  of  the 
cord  one  or  more  of  the  vessels  may  be  left  as  a  small 
granular  spot,  from  which  there  is  a  serous  or  sero- 
purulent  discharge,  an  eczema  of  the  skin  of  the  umbili- 
cus sometimes  following.  The  application  of  a  solution 
of  nitrate  of  silver,  thirty  or  forty  grains  to  the  ounce, 
followed  by  a  dry,  absorbent  dressing,  as  powdered 
boracic  acid  and  starch,  equal  parts,  this  being  repeated 
once  daily,  is  usually  efficacious. 

Umbilical  Hernia. — The  failure  of  the  umbilical 
ring  to  firmly  unite  after  the  cord  drops  off  is  the  chief 
cause.  Contributory  cause  is  the  continuous  crying  of 
babies  subject  to  colic,  hunger,  etc.,  or  who  strain  from 
constipation.  The  tumor  varies  in  size  from  a  small 
knuckle  to  a  large  protuberance. 

The  contents  of  the  sac  may  be  omentum  alone  or 
gut,  with  or  without  omentum. 

The  treatment  is  either  surgical  or  palliative.  Cures 
can  be  obtained  by  the  use  of  an  adhesive  strip  two 
inches  wide,  and  long  enough  to  reach  to  the  anterior 
axillary  line  on  each  side.  The  hernia  is  reduced,  a 
pad  is  made  of  a  button  mold,  covered  with  adhesive 
plaster,  or  of  several  thicknesses  of  plaster,  and  placed 
over  the  ring.  One  end  of  the  plaster  is  applied  and 
drawn  over  the  umbilicus,  the  pad  in  place,  and  the 
skin  over  the  umbilicus  drawn  up  into  small  folds. 
When  the  adhesive  plaster  is  changed,  which  should  be 


124  Obstetrical  Nursing 

done  every  four  or  five  days,  the  finger  is  placed  beneath 
the  pad  and  held  until  the  new  strip  is  applied. 

In  an  irreducible  hernia,  resort  should  be  had  to 
surgery  at  once. 

Atelectasis. — This  is  a  condition  of  the  lungs  in 
which  all  of  a  lobe  or  a  portion  of  one  remains  collapsed 
after  birth,  the  lung  remaining  as  in  the  fetal  state. 

The  condition  usually  follows  an  attack  of  asphyxia 
neonatorum.  If  the  primary  wiping  out  of  the  mouth 
and  nose  is  not  done,  mucus  may  be  aspirated  and 
mechanically  plug  up  one  of  the  bronchial  tubes,  perma- 
nently closing  it,  allowing  all  lung  tissue  supplied  by 
it  to  remain  collapsed. 

The  surface  of  the  lung  subject  of  atelectasis  shows 
depressions,  corresponding  to  the  undilated  portion, 
with  air  in  surrounding  tissue.  These  areas  do  not 
crepitate  on  pressure,  and  if  part  of  the  affected  portion 
is  excised  it  will  sink  in  water.  Much-dilated  bron- 
chioles, areas  of  compensatory  emphysema,  surround 
the  collapsed  portion. 

Practically  the  only  diagnostic  sign  of  importance 
is  the  presence  of  cyanosis,  with  no  heart  lesion  being 
found.  The  child  does  not  thrive,  is  bluish  in  color, 
especially  when  crying,  and  the  cry  is  feeble.  Con- 
vulsions may  rarely  be  seen.  The  physical  signs  are  of 
little  assistance  in  reaching  a  diagnosis.  Owing  to  the 
emphysematous  areas  around  the  atelectasis,  no  dull- 
ness or  bronchial  breathing  can  be  obtained.  The 
respiratory  murmur  is  feeble  and  slightly  harsher  than 
normal. 

The  principal  treatment  is  that  of  prevention,  by 
attempting  to  cause  the  child  to  take  deep  inspirations 
immediately  after  birth.  The  methods  of  artificial 
respiration  mentioned  elsewhere  should  be  employed 
early. 


Obstetrical  Nursing  125 

Sepsis. — This  condition  is  due  to  an  infection  of  the 
newborn  by  one  or  more  of  the  pus-producing  organ- 
isms, the  streptococcus  or  the  staphylococcus  being  the 
most  frequent  form.  The  most  favorable  site  for  en- 
trance of  the  organism  is  the  umbilicus,  either  before  or 
after  the  separation  of  the  stump.  The  infecting  organ- 
ism may  be  carried  to  this  point  by  the  capillary  action 
of  an  infected  napkin;  hence  the  necessity  for  an  anti- 
septic dressing  to  the  umbilicus  until  the  navel  has 
healed. 

The  following  portals  of  entry  of  the  organism  may 
be  mentioned:  Injuries  and  abrasions,  as  in  a  forceps 
operation,   with   an  infection   after  birth ;   abrasion   of 


H3 


J  M  M  5CO. 


I 


EIG.  50.      NASAI,  SYRINGE  WITH  RUBBER  TIP. 

the  mucous  membrane  of  the  mouth;  septicemia  of  the 
mother  during  the  later  weeks  of  pregnancy;  putrefac- 
tion of  the  liquor  amnii,  with  ingestion  or  aspiration  of 
this  by  the  child  before  and  during  labor;  or  a  violent 
vaginitis  and  endocervicitis  of  the  mother  before  birth 
and  infection  of  child  in  its  progress  through  the  canal ; 
suppuration  of  the  mammary  gland  during  lactation  and 
an  infection  of  a  milk  duct,  with  a  contamination  of 
the  milk,  the  infection  being  through  the  gastrointesti- 
nal tract;  or  an  infected  wound  following  clipping  of 
the  frenum  linguae  in  tongue-tie  or  following  circum- 
cision. 

The  first  evidence  of  the  condition  usually  appears 
during  the  first  week,  and  may  be  a  failure  of  the  child 
to  nurse.  If  the  infection  has  been  at  the  navel  and 
there  is  peritoneal  involvement,  or  an  inflammation  of  the 


126  Obstetrical  Nursing 

vessels  under  the  anterior  abdominal  wall,  there  is  con- 
tinuous crying,  distention  of  the  abdomen,  and  the  child 
lies  with  legs  drawn  up.  The  temperature  is  high  but 
fluctuating;  jaundice  is  present  when  the  liver  is  invol- 
ved; pulse  rapid  and  small;  skin  hot  and  dry,  and  there 
may  be  petechial  spots  develop  or  large  ecchymotic  areas 
— frequently  they  appear  on  the  part  which  is  in  contact 
with  pillow  and  bed.     The  prognosis  is  very  grave. 

Support  and  nourishment  offer  the  only  possible  hope 
of  relief.  If  the  child  is  unable  to  nurse,  rectal  feeding 
and  gavage  must  be  resorted  to,  using  by  the  former 
completely  peptonized  milk,  and  by  gavage,  breast  milk, 
if  it  can  be  obtained. 

Injuries  to  the  Newborn. — As  a  result  of  prolonged 
labor,  pelvic  deformities,  with  instrumental  or  manual 
delivery  to  overcome  these  conditions,  the  child  may 
sustain  fatal  injuries,  or  injuries  which  may  cripple  it 
for  life. 

High  Forceps  is  a  capital  operation,  with  very 
serious  results  in  a  large  percentage  of  cases.  Williams, 
in  one  hundred  and  nineteen  collected  cases  of  high  for- 
ceps, found  a  maternal  mortality  of  40  per  cent  and  an 
infantile  mortality  of  60  per  cent. 

As  a  result  of  forceps  operation  the  following  injur- 
ies may  be  named:  lacerations  of  the  skin  by  the  blades; 
injury  to  eye,  especially  when  a  fenestrated  blade  is 
applied  too  far  up  on  the  head;  facial  paralysis;  de- 
pressed cranial  bone,  or  a  fracture  of  the  bones;  cerebral 
hemorrhage  from  rupture  of  vessels  in  the  meninges  or 
brain. 

Version  may  result  seriously  to  a  living  child. 
A  mono-  the  most  frequent  aecidents  are  fractures  of  the 
long  bones  of  the  extremities  and  the  clavicle;  laceration 
or   rupture    or   hematoma    of    the    sterno-cleido-mastoid 


Obstetrical  Nursing  127 

muscle ;  fracture  and  depression  of  the  cranial  bones ; 
rupture  of  vessels  in  the  meninges  or  of  the  sinuses  in  the 
dura;  Erb's  paralysis  from  pressure  on  the  brachial 
plexus  of  nerves;  atelectasis  from  delayed  delivery  of 
the  after-coming  head. 

Tetanus  (Lockjaw). — Tetanus  is  due  to  the  entrance 
of  the  tetanus  bacillus  into  the  circulation,  its  toxins 
exerting  their  effect  particularly  upon  the  central  nerv- 
ous system.  The  bacillus  may  enter  at  the  umbilicus 
or  an  abrasion  of  the  skin,  carried  through  the  medium 
of  unclean  hands,  dressings,  etc.  The  principal  habitat 
of  the  bacillus  is  in  the  neighborhood  of  stables  and 
stable  yards,  and  dust  and  dirt  from  this  locality  may 
convey  the  infection. 

In  a  majority  of  cases  the  symptoms  appear  during 
the  first  week  after  birth,  though  it  may  occur  any  time 
before  the  fourteenth  day.  It  is  rare  during  the  third 
week. 

The  first  symptom  is  a  spasmodic  contraction  of  the 
muscles  of  the  lower  jaw,  which  very  soon  becomes  fixed, 
tightly  closed.  It  is  impossible  to  push  the  nipple 
between  the  child's  gums.  If  liquids  are  poured  into 
the  mouth,  swallowing  is  impossible,  and  the  first  few 
drops  passing  the  pharynx  may  cause  a  reflex  spasm  of 
the  pharyngeal  muscles  and  a  general  convulsion.  The 
child  has  an  anxious,  frowning  look  between  the  spasms, 
and  a  more  or  less  general  spasmodic  contraction  of  the 
facial  muscles  during  a  convulsion.  During  a  general 
convulsion  the  respirations  are  stertorous,  and  between 
they  are  hurried  and  superficial.  The  sphincters  of  blad- 
der and  rectum  are  relaxed,  and  involuntary  passages  are 
usual.  As  the  case  progresses  the  periods  of  rest  be- 
tween the  convulsions  are  shorter,  contractions  begin, 
the   spine   becomes   contracted,    arching   backward,   the 


12S  Obstetrical  Nursing 

opisthotonos  being  at  times  extreme,  the  child  resting 
on  head  and  heels.  The  temperature  is  usually  very 
high,  104:°  F.  to  106°  F.  In  the  latter  period  a  con- 
vulsion may  be  induced  by  touching  the  child,  especially 
about  the  face.     Feeding  is  impossible. 

The  prognosis  is  very  grave,  as  nearly  all  cases  die. 
The  younger  the  child  the  more  hopeless  the  case. 
Escherich  reports  several  recoveries. 

The  diagnosis  is  usually  easy,  and  must  be  made  from 
the  meningitis  and  from  the  paralyses  and  contractions 
following  cerebral  hemorrhages  of  the  newborn. 

The  most  favorable  results  can  be  had  from  the  use 
of  the  tetanus  antitoxin,  which,  like  the  diphtheria  anti- 
toxin, gives  the  best  results  the  earlier  it  is  used.  Five 
to  ten  cubic  centimeters  of  the  antitoxin  may  be  injected, 
and  repeated  in  from  six  to  eight  hours.  The  subcu- 
taneous method  is  recommended  rather  than  the  injection 
into  the  spinal  canal,  owing  to  the  difficulty  of  perform- 
ing the  latter  operation.  The  influence  upon  the  minds  of 
the  family  by  the  lumbar  puncture  is  very  great,  and  a 
fatal  result  of  the  disease  is  usually  attributed  to  the 
puncture  by  the  average  layman. 

Prophylaxis  is  the  chief  treatment,  strict  cleanliness 
in  tying  the  cord  and  its  care  afterward  being  an  abso- 
lute essential.  Upon  the  appearance  of  the  symptoms, 
control  the  convulsions,  if  they  are  severe,  by  inhala- 
tions of  chloroform. 

Gavage  should  be  resorted  to,  with  the  tube  intro- 
< lured  through  the  nose,  in  those  cases  in  which  improve- 
ment is  noted  in  the  convulsive  stage. 


CHAPTER  VII. 
Infant  Feeding. 

Every  mother  should  he  encouraged  to  nurse  her 
infant,  unless  some  special  and  vital  reasons  exist  why 
she  should  not  do  so.  The  following  are  among  these 
contraindications  to  maternal  nursing:  prolonged  illness 
before  delivery ;  severe  anemia ;  tuberculosis ;  depressed 
or  severely  deformed  nipples ;  epilepsy ;  syphilis ;  chronic 
rheumatism;  puerperal  fever;  an  insufficient  supply  of 
milk;  milk  of  bad  quality,  which  continuously  disagrees 
with  the  child,  efforts  at  regulation  by  diet,  etc.,  failing 
to  correct  it. 

A  newborn  child  should  be  fed  every  two  hours 
during  the  day,  and  every  three  or  four  hours  during 
the  night.  After  the  third  month  feed  every  three 
hours  during  the  day  and  once  at  night.  Feeding 
oftener  at  night  results  in  indigestion  and  colic,  and  if 
fed  whenever  it  cries  or  "wants  it"  during  the  day 
this  is  bound  to  result.  It  has  been  advised  by  some 
that  if  the  baby  is  not  put  to  the  breast  at  all  during  the 
first  two  days  and  nights  there  is  much  less  danger  to  the 
mother's  nipples.  By  the  pulling  and  tugging  at  the 
practically  empty  breasts  the  nipples  are  excoriated  or 
cracked.  This  plan  means  disturbed  rest  for  the  nurse, 
but  gives  much  comfort  to  the  mother.  If  put  to  the 
breast  early  it  should  not  be  until  after  the  first  eight 
or  ten  hours,  during  which  time  the  mother  is  enabled 
to  a  certain  extent  to  regain  her  strength  lost  during  the 
labor.  If  there  is  a  tendency  to  hemorrhage  from  the 
uterus  the  nursing  excites  a  uterine  contraction  and 
acts  beneficially.     This  is  the  only  indication,  however, 


130  Obstetrical  Nursing 

for  immediate  nursing.  The  administration  of  sweet- 
ened water  until  the  milk  comes  in  the  breast  generally 
suffices  to  satisfy  and  sustain  the  infant. 

The  practice  of  feeding  a  newborn  child  catnip  tea 
and  other  decoctions  is  pernicious.  If  Nature  had  in- 
tended the  breasts  to  secrete  a  nourishment  during  the 
first  two  days  it  is  reasonable  to  suppose  there  would  be 
an  appearance  of  milk  with  the  beginning  or  end  of 
labor.  Water  sustains  an  infant  fufil  well  until  the  milk 
appears.  There  may  be  an  oversupply  of  milk,  called 
galactorrhea,  milk  constantly  running  from  the  breast, 
which  necessitates  the  wearing  of  cloths  for  protection 
of  the  clothing.  The  milk  when  it  first  appears  may 
come  with  a  rush,  filling  the  breasts  quickly,  perhaps 
causing  much  pain,  the  child  being  unable  to  nurse  it 
out  fast  enough  to  give  comfort.  Ordinarily  after  the 
first  rush  of  the  milk  is  over  it  can  be  felt  to  come  into 
the  breasts  with  a  prickling  sensation  when  the  child 
is  taken  for  its  nursing,  or,  if  regularity  in  nursing  has 
been  early  established,  this  sensation  will  be  felt  at  the 
regular  nursing  hour  without  seeing  the  child. 

The  child  will  obtain  ample  nourishment  by  nursing 
from  alternate  breasts,  taking  at  least  ten  minutes  for 
exhausting  the  supply.  It  should  be  made  to  work 
while  at  the  breast,  waking  it  up  if  inclined  to  fall 
asleep,  as  babies  are  prone  to  do. 

Examination  of  Breast  Milk. — If  the  milk  of  a  mother 
does  not  agree  with  the  child  it  should  be  examined 
carefully  by  the  physician,  to  ascertain  the  reason  for 
its  disagreement.  The  sample  for  examination  is  best 
obtained  by  either  pumping  it  out  or  pressing  it  out  by 
the  hand  in  the  middle  of  a  nursing.  The  fore  milk 
is  poor  in  fat  and  rich  in  solids,  the  "strippings"  very 
rich  in  fat,  the  middle  milk  being  the  average.     Let  the 


Obstetrical  Nursing  1.31 

child  nurse  for  a  few  minutes  from  both  breasts,  then 
press  the  milk  out,  obtaining  at  least  two  tablespoonfuls 
(one  ounce).  This  is  placed  in  a  clean  bottle  in  a  cool 
place,  to  be  sent  to  the  doctor,  marked  with  name  of 
patient  and  date. 

Duration  of  Nursing  Period. — Lactation  usually  lasts 
from  eight  to  ten  months,  weaning  being  accomplished 
gradually  as  a  rule,  it  being  usually  best  not  to  change 
the  baby 's  food  during  the  heated  term. 

The  average  time  for  the  reappearance  of  the  menses 
is  when  the  baby  is  seven  months  old,  though  it  may 
reappear  before  that  time.  It  is  not  infrequent  for  it 
to  reappear  during  the  second  month  and  recur  regularly 
during  the  whole  of  lactation.  As  colostrum  frequently 
reappears  in  the  milk  during  menstruation,  and  under 
stress  of  excitement,  fear,  anger,  or  any  great  emotion, 
it  may  cause  some  indigestion  in  the  infant,  acting  as  a 
laxative,  perhaps  causing  vomiting. 

Should  a  nursing  mother  conceive,  the  child  at  the 
breast  must  be  weaned,  as  it  is  unjust  to  both  children 
that  nursing  be  continued.  As  soon  as  it  is  known 
another  pregnancy  has  begun,  a  physician  is  consulted 
as  to  the  proper  course  to  pursue. 

Wet-nurse. — Should  a  mother  be  unable  to  nurse  her 
child  a  wet-nurse  is  the  next  best  method  of  nourishing 
it,  but  there  are  many  obstacles  in  the  way  of  obtaining 
one;  it  is  difficult  to  find  one  whose  baby's  age  is  near 
to  that  of  the  baby  to  be  nursed,  the  danger  of  a  good 
milk  on  the  diet  she  is  used  to  at  home  being  so  altered 
by  her  change  of  food,  surroundings,  habits,  etc.,  as  to 
make  it  disagree  with  both  the  babies. 

Artificial  Feeding. — Should  artificial  feeding  be  de- 
cided upon,  the  choice  of  food  is  of  great  moment.  The 
consensus  of  opinion  of  all  observers  is  that  cow's  milk, 


132  Obstetrical  Nursing 

modified  for  the  individual  child's  needs,  is  the  nearest 
approach  to  a  good  breast  milk. 

The  following  table  gives  the  average  percentage  of 
the  various  ingredients  in  cow 's  and  human  milk : 

Cow's         Human 
Milk.  Milk. 

Water     87.41  87.30 

Solids   12.50  12.46 

Fat    3.66  4.00 

Sugar    4.50  7.00 

Proteids     4.00  1.50 

It  can  be  seen  at  a  glance  that  cow's  milk  without 
some  change  can  not  be  digested  by  the  child  because  of 
the  excess  of  proteids,  or  casein,  which  is  the  solid  part 
of  the  milk. 

Milk  Modification. — A  modification  of  the  milk  may 
be  accomplished  in  several  wTays :  by  the  accurate  and 
scientific  method  in  the  milk  laboratory,  such  as  the 
Walker-Gordon  or  the  Neill  Roach  adapted  milk  labora- 
tories; or  at  home  by  the  various  formula?  devised  by 
workers  in  this  line.  As  these  laboratories  are  only 
available  in  a  few  cities,  the  milk  must  often  be  modified 
at  home. 

By  the  term  "modified  milk"  or  "adapted  milk" 
we  mean  the  changing  of  cow's  milk  by  its  dilution  and 
the  addition  of  cream  and  milk  sugar  until  its  analysis 
approaches  that  of  mother's  milk. 


FIG.  51.      CHAPIN  CREAM  DIPPER. 

We  ran  take  cow's  milk  as  the  basis,  dilute  it  with 
water  or  other  diluent,  as  barley,  rice,  or  oatmeal  water, 
and  add  cream  to  bring  up  the  percentage  of  fat,  and 


Obstetrical  Nursing  133 

milk  sugar.     The  upper  fatty  milk  can  also  be  taken, 
diluting  it  and  adding  milk  sugar. 

The  following  is  a  table  suggested  by  Doctor  Henry 
D.  Chapin  for  the  modification  of  milk  at  home  which  is 
simple  and  accurate,  being  easily  understood  by  any  one : 


FIG.  52.      QUART  BOTTLE  OF  CERTIFIED    MILK,  SHOWING 
CREAM  LINE. 

Allow  a  quart  of  milk  to  stand  in  a  cool  place  for 
four  hours,  dip*  off  the  top  eleven  ounces,  wmich  on 
analysis  will  show  a  cream  containing  10  per  cent  of 
butter  fat.  Of  these  eleven  ounces  take  the  quantity 
specified  below,  adding  one  ounce  of  lime  water  and  one 
ounce  of  milk  sugar  and  enough  water  to  make  twenty 
ounces. 

The  following  tables  explain  themselves : 

One  ounce  of  the  top  eleven  ounces,  added  to  nineteen 


*The  top  milk  is  removed  by  means  of  a  dipper  holding  one  ounce,  as 
indicated  in  the  illustration,  Fig.  51.  These  dippers  are  supplied 
by  the   Cereo   Company,   Tappan,   N.   Y. 


134 


Obstetrical  Nursing 


ounces  of  water,  makes  a  solution  which  analyzes 
50,  sugar  5.20,  proteids  .17. 


fat 


Fat. 

2  ounces  1. 

3  ounces 1.50 

4  ounces  2.00 

5  ounces  2.50 

6  ounces  3.00 

7  ounces 3.50 


Sugar. 

Proteids 

5.40 

.33 

5.60 

.50 

5.85 

.66 

6.05 

.83 

6.25 

1.00 

6.50 

1.20 

In  preparing  the  food  special  vessels  should  be  used 
and  carefully  cleaned  after  using.     The  following  are 


■***&■*■ 


EEsSg/ 


FIG.  53.      DEMING  MILK  MODIFIER. 

needed:  a  white  enamel  or  glass  pitcher;  bowl;  table- 
spoon;  an   apothecary's   eight-ounce   graduate;   Chapm 


Obstetrical  Nursing  135 

cream  dipper,  or  bent  glass  tube,  for  obtaining  top  milk ; 
funnel ;  milk  sugar ;  absorbent  cotton,  and  lime  water. 
They  should  be  kept  covered  to  protect  them  from  the 
dust  when  not  being  used. 

Cow's  Milk. — The  milk  used  in  artificial  feeding 
must  be  as  pure  as  it  is  possible  to  obtain  it. 

It  must  be  drawn  from  healthy  cows,  shown  to  be 
free  from  tuberculosis  by  the  tuberculin  test;  they  must 
be  groomed  and  milked  in  clean  barns,  properly  built 
with  concrete  floors  and  free  from  dust,  by  healthy 
milkers  in  clean  washed  suits,  with  clean  hands,  into 
sterilized  covered  pails  with  small  openings.  The  milk 
must  be  aerated,  cooled,  and  bottled  at  once,  iced  and 
kept  cold  until  delivered,  and  put  on  ice  until  modified. 
Milk  produced  in  this  way,  which  after  examination  is 
found  to  be  chemically  up  to  the  standard  and  bacteri- 
ologically  to  contain  less  than  10,000  bacteria  to  the 
cubic  centimeter,  can  be  certified  to  by  a  commission  of 
physicians  as  coming  up  to  the  required  standard,  and 
is  known  as  certified  milk.  In  several  States  the  use  of 
this  term  is  restricted  by  law  to  milk  certified  to  by  a 
commission  of  physicians. 

Quantity  of  Feeding. — The  quantity  to  be  given 
at  a  feeding  is  of  great  importance,  and  below  follows  a 
table  of  amounts  which  can  be  given  an  infant  at  differ- 
ent ages : 

TntD.,.oll!    No.  Feed-   Amount  Each         Amount  24 
AGE.  TTmirs         inSs'  24  Feeding,  Hours, 

Hours.  Ounces.  Ounces. 

First     week 2  10                  1                         10 

One  to  six  weeks ^___  2  10  1%  to  214  15  to  25 

Six  to  twelve  weeks 2V2  8  2%  to  3y2  20  to  2S 

Three  to  six  months 2^>  6                 6                         36 

Six  to  nine  months 3  6                  8                          48 

Nine   to   twelve   months- _  3  5                  8                          40 


136 


0 b stetrical  Nu rsin g 


Schedule  of  Feeding. 

AGK. 

First    three    days 

Until  end  of  first  month- _. 
Second  and  third  months.  _ 
Fourth  and  fifth  months--. 
Sixth  to  twelfth   months- _. 

Care  of  Bottles  and  Nipples. — Definite  and  positive 
directions  must  be  given  the  mother  and  the  nurse,  in  her 
presence,  as  to  the  care  of  the  bottles  and  nipples,  and 
a  bottle  selected  which  is  the  easiest  to  clean.   The  Hygeia 


Intervals, 
Day. 

No.  Night 
Feedings. 

No.  Feedings, 
24  Hours. 

4  to  6 

1 

4  to  6 

2 

2 

10 

2% 
3 

1 
1 

8 

7 

o 
o 

0 

6 

FIG.  54.      HYGEIA  NURSING  BOTTLES. 

nursing  bottle  has  a  wide  mouth  and  a  large  rubber  nip- 
ple, both  of  which  are  very  easily  cleaned  and  sterilized. 
The  Arnold  Pasteurizing  Bottle  is  difficult  to  clean 
because  of  the  narrow  opening,  it  being  necessary  to 
use  a  brush  in  washing.  The  same  objection  obtains  in 
the  Whitehall-Tatum  Bottle,  which  has  a  wide,  flaring 
base. 

New  bottles  can  be  annealed  by  placing  them  in  a 
vessel  of  cold  water,  bringing  it  to  a  boil,  allowing  the 
bottles  to  remain  in  the  water  until  cold.  They  crack 
less  readily  when  so  treated. 

If  more  milk  has  been  prepared  than  the  baby  will 
take  at  a  nursing,  the  bottle  should  at  once  be  emptied 
when  the  child  has  finished,  rinsed  with  cold  water,  then 


Obstetrical  Nursing  127 

with  hot,  and  filled  with  soda  solution,  which  is  allowed 
to  remain  in  it  until  the  milk  is  prepared  the  following 
day  for  the  next  twenty-four  hours.  The  bottles  are 
then  partly  filled  with  soap  and  water,  a  tablespoonful 
of  bird  gravel  is  poured  in  and  the  bottles  each  thorough- 
ly shaken,  this  doing  away  with  the  necessity  for  a  brush. 
They  are  then  rinsed  and  boiled  and  kept  standing  bot- 
tom up  ready  for  use. 

Enough  nipples  should  be  at  hand  to  use  a  different 
one  for  each  feeding.     After  a  feeding  they  are  washed, 


FIG.  55.      RUBBER  NIPPLE. 

turned  inside  out,  and  allowed  to  remain  in  a  soda  or 
boracic  acid  solution  and  boiled  with  the  bottles  the 
following  day.  Under  no  circumstances  should  a  long- 
tube  nursing  bottle  ever  be  used.  It  is  absolutely  im- 
possible to  cleanse  the  tube,  and  it  is  a  constant  source 
of  infection. 

The  aperture  in  a  nipple  should  only  be  large  enough 
to  allow  milk  to  escape  from  it,  with  the  bottle  inverted, 
in  drops  in  quick  succession.  If  it  drops  very  slowly 
the  opening  is  too  small,  and  may  be  enlarged  very  little 
by  the  point  of  a  hot  needle.  If  the  milk  runs  in  a  fine 
stream  the  opening  is  too  large  and  the  nipple  should  be 
discarded. 

The  bottle  is  stood  in  a  cup  of  hot  water  until  the 


138 


0 b Metrical  Nursing 


milk  is  about  90°  F.  The  temperature  of  the  milk  can 
be  ascertained  by  allowing  a  few  drops  to  trickle  on  the 
back  of  the  hand  or  wrist.  The  practice  of  some  nurses 
of  drawing  a  few  drops  from  the  nipple  with  the  mouth 
to  learn  the  temperature  of  the  milk  can  not  be  too 
strongly  condemned. 

Water. — It  must  be  remembered  that  an  infant  needs 
water  as  much  as  an  adult,  and  this  must  be  given  fre- 
quently during  the  day.  Cool  or  warm  water  can  be 
given  through  a  nursing  bottle  three  or  four  times  a  day. 

Sterilization  and  Pasteurization. — Milk  brought  to 
the  temperature  of  212°  F.  for  fifteen  minutes  is  steril- 
ized; when  brought  to  140°  F.  to  170°  F.  for  twenty 
minutes  is  pasteurized,  the  difference  being  entirely  in 
the  amount  of  heat  used.  Sohxlet,  in  1886,  advised  the 
heating  of  milk  for  infant  feeding,  and  described  an 
apparatus  for  carrying  this  out  in  the  home.     When  it 


FIG.  56.      HVGEIA  STERILIZER. 


is  impossible  to  obtain  a  milk  for  infant  feeding  which 
is  known  to  be  clean  and  cold,  or  the  milk  contains  a 
quantity  of  sediment  and  sours  easily,  it  is  decidedly 
best  to  submit  it  before  feeding  to  sterilization  or  pas- 
teurization. Pasteurized  milk  means  "heated  milk,"  and 
does  not  necessarily  mean  "clean,  good,  or  pure  milk." 
Both  of  these  processes  destroy  bacteria,  but  do  not 


Obstetrical  Nursing  139 

entirely  destroy  their  spores.  The  germs  most  frequently 
found  in  milk  are  the  tubercle  bacillus,  typhoid  bacillus, 
Klebs-Loeffler  bacillus,  the  pyogenic  cocci,  and  the  virus 
of  foot-and-mouth  disease  of  cattle.  These  are  all  killed 
at  even  a  lower  temperature  than  167°  F.  if  maintained 
long  enough. 

The  chief  difficulty  in  wholesale  pasteurization  of 
milk  is  its  being  heated  in  bulk  and  put  in  unsterilized 
containers,  either  bottles  or  cans.  To  be  entirely  ef- 
fective it  should  be  first  bottled,  under  as  strict  cleanly 
auspices  as  possible,  then  pasteurized,  cooled  imme- 
diately, and  kept  cold  until  consumed.  Unfortunately 
the  pasteurization  or  sterilization  of  milk  lulls  one  into 
a  false  feeling  of  security  in  regard  to  it.  The  general 
belief  is  that  the  milk  so  treated  wTill  keep  indefinitely 
and  without  ice,  whereas  if  such  a  sample  of  pasteurized 
milk  is  plated  it  will  be  found  to  contain  many  thousand 
bacteria. 

Effect  of  Heat. — Owing  to  the  lactic  acid  bacteria 
being  destroyed  by  heat,  milk  so  treated  does  not  sour, 
but  slowly  putrefies.  The  growth  of  the  putrefying 
bacteria  in  raw  milk  is  inhibited  by  the  lactic  acid  bac- 
teria. The  effect  of  heat  upon  milk  depends  upon  the 
degree  of  heat,  but  it  so  changes  the  proteid  that  it  is 
difficult  to  digest  by  the  infant  stomach.  It  to  some 
extent  coagulates  the  albumen  and  renders  the  milk  less 
coagulable  by  rennet.  The  exact  change  which  takes 
place  is  not  known,  but  the  clinical  evidence  abundantly 
proves  that  pasteurized  and  sterilized  milk  do  not  meet 
the  needs  of  infant  nutrition,  as  rickets  and  scurvy,  both 
nutritional  disorders,  occur  where  this  milk  is  exclusively 
fed. 

Artificial  Foods. — The  fact  that  there  are  upon  the 
market  almost  countless  numbers  of  baby  foods  is  evi- 


140  Obstetrical  Nursing 

dence  enough  that  none  answers  the  requirements  in  all 
cases.  These  foods  may  be  divided  into  three  classes. 
First,  the  so-called  milk  foods  to  which  water  is  added, 
and  those  foods  in  the  form  of  powder  which  have  been 
suggested  as  modifiers  of  milk.  The  latter  are  added 
to  milk  for  their  influence  upon  the  casein.  Second,  the 
so-called  Liebig  or  malted  foods;  and  third,  the  farina- 
ceous foods.  In  the  second  class  the  starches  are  sup- 
posed to  have  been  entirely  converted  into  soluble  sugars 
by  the  diastatic  action  of  the  malt.  In  the  third  class 
but  a  small  portion  of  the  starch  is  converted  by  the 
process  of  cooking. 

A  nurse  should  never  recommend  an  artificial  food  or 
a  modified  milk  formula,  leaving  this  strictly  in  the  hands 
of  the  attending  physician.  Too  much  emphasis  can  not 
be  laid  upon  this. 

Gavage. — This  method  of  feeding  is  a  valuable  one 
in  certain  classes  of  cases  in  which  a  child  will  not  eat 
or  is  too  weak  to  do  so,  or  in  which  vomiting  occurs  im- 
mediately after  food  is  taken.  The  same  steps  are  taken 
as  in  stomach  washing.  The  food  mixture  is  poured  into 
the  funnel,  and  when  it  has  been  seen  to  pass  the  glass 
tube  connecting  the  catheter  with  the  rubber  tube  the 
catheter  is  compressed  tightly  and  quickly  withdrawn. 
Gavage  may  be  performed  with  the  patient  in  a  recum- 
bent position  or  held  upright  in  the  nurse's  lap,  leaning 
against  her  shoulder.  In  many  cases  of  persistent  vomit- 
ing, water  or  food  introduced  into  the  stomach  through 
the  tube  will  be  retained  when  a  very  much  smaller 
quantity  given  by  the  mouth  from  a  spoon  or  bottle  will 
not  be  retained.  Young  children  stand  the  introduction 
of  the  tube  without  discomfort,  and  gavage  can  be  used 
for  ;i  very  much  longer  period  of  time  than  rectal  feeding 
ean  possibly  be  tolerated.     A  very  weak  modified  milk, 


Obstetrical  Nursing  141 

plain  or  peptonized,  cereal  decoctions,  the  concentrated 
foods,  as  panopepton  and  stimulants,  may  be  given  in 
this  way.  In  cases  of  diphtheria  or  those  wearing  an 
intubation  tube,  the  stomach  tube  is  best  introduced 
through  the  nares. 

Rectal  Feeding. — This  method  of  nourishment  is 
a  valuable  one  when  all  others  have  failed,  and  may  be 
the  means  of  tiding  over  a  desperate  case  until  nourish- 
ment can  be  given  in  other  ways.  The  food  for  admin- 
istration in  this  way  should  be  as  nearly  as  possible 
free  from  fat  and  completely  peptonized.  Completely 
peptonized  or  pancreatized  skimmed  milk,  mixed  with 
albumen  water  of  double  strength,  namely,  the  whites 
of  two  eggs  and  a  pint  of  water,  can  be  used  to  ad- 
vantage. This  should  be  heated  to  about  100°  F.,  as 
it  loses  several  degrees  of  heat  in  its  passage  through  the 
tube  of  the  fountain  syringe,  if  this  syringe  is  used  to 
insert  it.  The  food  is  best  inserted  through  a  small- 
sized  short  rectal  tube  (No.  14A),  which  can  be  attached 
to  a  small  rubber  tube  of  the  fountain  syringe,  or  the 
fluid  can  be  injected  with  a  hard  rubber  or  glass  piston 
syringe;  care  must  be  taken  to  invert  the  syringe,  to  be 
sure  that  all  of  the  air  is  expelled.  The  child  is  placed 
upon  its  left  side,  hips  elevated  by  raising  upon  a  rub- 
ber-covered pillow,  its  thighs  flexed  upon  its  abdomen 
much  as  in  the  Sims'  position;  the  tube  is  anointed  well 
with  vaseline  from  a  tube,  and  the  external  sphincter 
is  also  greased.  The  tube  is  then  inserted  slowly  to  the 
distance  of  nine  or  ten  inches  and  the  nutrient  enema 
slowly  injected.  Not  more  than  three  ounces  should 
be  injected  in  a  child  of  six  months  of  age,  nor  more 
than  six  ounces  in  a  child  of  three  years  of  age.  After 
the  injection  the  tube  is  compressed  and  quickly  with 
drawn,  the  child's  buttocks  compressed  firmly,  and  the 


142  Obstetrical  Nursing 

child  held  in  the  original  position,  if  possible;  if  not, 
it  is  allowed  to  lie  upon  its  back  with  legs  and  thighs 
flexed.  If  these  enemas  are  given  much  oftener  than 
this,  the  bowel  soon  becomes  intolerant  and  they  are 
expelled  as  soon  as  introduced. 

In  this  connection  might  be  mentioned  the  great 
benefit  obtained  from  the  high  colon  injection  of  water 
in  cases  of  deficient  kidney  excretion,  as  the  absorption 
from  the  colon  is  both  rapid  and  prompt.  The  method 
of  Murphy,  suggested  originally  for  use  in  septic 
peritonitis  in  both  adults  and  children,  namely,  the 
continuous  colonic  flushing,  may  also  be  employed  to 
advantage.  It  might  be  well  before  the  injection  of 
the  nutrient  enema  to  give  a  preliminary  colon  irriga- 
tion, to  thoroughly  cleanse  the  lower  bowel  and  render 
it  more  absorbent. 


CHAPTER  VIII. 
Operative  Obstetrics. 

The  same  dangers  are  present  in  obstetric  surgery 
as  in  general  surgery,  hence  the  necessity  for  the  major 
obstetric  operations  being  performed  in  a  well-equipped 
hospital  whenever  possible.  The  hardships  incident  to 
the  transportation  of  a  patient  in  hard  labor  a  great  dis- 
tance must  be  taken  into  consideration,  but  where  pos- 
sible the  patient  should  be  moved  for  the  following 
operations :  Cesarean  section ;  vaginal  Cassarean  sec- 
tion; induction  of  premature  labor;  craniotomy. 

For  other  operations,  as  forceps,  version,  perineor- 
rhaphy, etc.,  the  preparations  are  the  same  as  for  any 
surgical  operation,  and  the  room  arranged  as  much  like 
a  hospital  delivery-room  as  possible. 

Preparation  of  Room. — The  room  selected  for  the 
operation  must  be  well  heated  and  lighted,  and  if  not 
recently  cleaned  it  is  best  to  be  content  with  a  thorough 
sweeping,  with  windows  open,  some  hours  before  the 
operation ;  but  if  the  time  is  limited  it  is  better  not  to 
do  any  cleaning  which  will  raise  a  dust.  The  table 
should  be  placed  near  a  window,  to  receive  the  daylight 
most  advantageously,  or  convenient  to  artificial  light  at 
night. 

For  all  obstetric  operations  a  table  is  a  very  necessary 
part  of  the  equipment,  and  a  kitchen  table,  over  which  is 
spread  a  folded  comfort  or  blanket  protected  by  a  sterile 
sheet,  makes  an  excellent  operating  table. 

If  the  floor  is  covered  by  a  rug  it  should  be  rolled 
up  and  removed  or  pulled  back  from  the  table,  or  the 
carpet  protected  by  heavy  paper,  newspapers,  or  rubber 
sheet.     A  sewing  or  card  table  is  used  for  the  instru- 


144  Obstetrical  Nursing 

ments,  basin  containing  sterile  water  or  solutions  and 
sponges,  and  another  for  dressings,  towels,  etc.  One  or 
two  straight-back  or  kitchen  chairs  should  be  near  by. 
These  are  especially  needed  in  forceps  operations  and 
perineorrhaphy.  All  the  available  basins  and  bowls  must 
be  thoroughly  sterilized  by  scrubbing  with  brush,  soap, 
and  sterile  water,  rinsed  with  boiling  water,  and  finally 
baked  in  the  oven  of  the  kitchen  stove.  They  are  then 
covered  with  a  sterile  sheet  until  ready  for  use.  There 
must  be  plenty  of  boiled  water,  sterile  towels  (rendered 
so  by  baking),  sterile  gauze  and  cotton,  with  all  the  other 
paraphernalia  required  for  any  ordinary  labor. 

A  foot-tub  partly  filled  with  hot  water,  with  pitchers 
of  hot  and  cold  sterile  water,  should  be  provided  for  use 
as  soon  as  the  child  is  born,  in  case  it  be  asphyxiated, 
as  is  so  often  the  case  in  these  operations.  The  same 
preparations  are  necessary  to  receive  the  baby  and 
after-birth  delivered  by  operation  as  if  born  normally. 

Preparation  of  Bed. — If  the  operation  is  to  be  done 
at  home,  and  a  table  can  not  be  obtained,  the  bed  is 
prepared.  If  for  forceps,  version,  or  primary  repair 
of  perineum  or  cervix,  a  "cross-bed"  is  arranged.  If 
the  bed  is  a  single  one  it  is  prepared  as  for  a  normal 
Labor,  with  rubber  sheet  over  a  firm  mattress,  linen  sheet 
and  draw  sheet,  the  latter  pinned  securely.  A  folded 
sheet  is  brought  close  down  to  the  edge  of  the  bed,  and 
over  this  is  placed  an  inflated  obstetrical  rubber  cushion, 
or  Kelly  pad,  or  if  this  is  not  at  hand  a  rubber  sheet, 
its  free  end  placed  over  a  vessel  at  the  edge  of  the  bed 
to  carry  the  discharges  into  it.  Th<>  upper  portion  of 
this  pad  is  raised  by  being  laid  over  a  folded  towel  or 
sheet,  to  keep  the  solutions  from  running  up  the 
I  atient's  back. 

Preparation  of  Patient. — For  a  section  the  patient 


Obstetrical  Nursing 


145 


is  prepared  as  for  any  other  abdominal  operation — the 
pubic  hair  shaved  and  the  abdomen  scrubbed.  Soap 
and  water  is  used  liberally,  followed  by  a  lysol,  car- 
bolic, or  bichloride  solution,  as  preferred  by  the  opera- 
tor, and  alcohol. 


FIG.  57.      PATIENT  WITH  I,EGS  HEI,D  BY  FOLDED  SHEET, 
FOR   OPERATION. 

If  the  operation  is  a  vaginal  one,  the  vulva  is  pre- 
pared by  the  nurse,  vulva  hair  clipped  close,  thoroughly 
cleansed,  and  the  final  preparations  left  to  the  operator 
after  the  patient  is  in  position.  Douches  and  cleansing 
of  the  vagina  are  usually  dispensed  with  in  obstetric 
surgery,  as  the  natural  secretions  are  helpful  during  the 
birth.     The  patient  should  be  catheterized  before  any 


146 


Obstetrical  Nursing 


operative  interference,  and  always  by  a  rubber  catheter 
during  labor. 

If  the  operation  is  performed  on  the  bed,  the  patient 
is  anesthetized  and  placed  crosswise  in  the  bed,  her  hips 
close  to  the  edge,  the  legs  held  in  the  lithotomy  position, 
flexed  well  on  the  thighs  and  thighs  on  the  abdomen, 
and  held  by  means  of  one  of  the  specially  devised  leg 


FIG.  58.      IyEG   HOLDERS. 

holders,  or  if  these  are  not  obtainable,  a  sheet  can  be 
placed  under  the  neck,  brought  over  the  shoulders,  and 
the  ends  tied  around  the  thighs  while  they  are  being 
held  well  flexed  on  the  abdomen.  By  this  means  the 
legs  are  held  out  of  the  way  without  the  necessity  of 
having  other  assistance  than  that  of  the  nurse. 

Preparation  of  Instruments. — The  obstetrician  usu- 
ally carries  the  necessary  instruments  in  his  obstetrical 
bag,  and  these  must  be  sterilized  by  boiling  for  not  less 
than  fifteen  minutes  in  a  fish  boiler,  wash  boiler,  or 
large  dishpan,  after  thorough  scrubbing  of  these  uten- 


Obstetrical  Nursing  147 

sils.  The  addition  of  a  small  quantity  of  soda  to  the 
water  will  prevent  tarnishing  of  the  instruments.  The 
forceps  may   be   brought   into   the   room   in   the   boiler 


FIG.  59.   RUBBER  OBSTETRICAL  CUSHION. 

or  in  a  deep  pitcher  containing  a  cool  lysol  solution,  so 
that  the  blades  are  not  too  hot  when  introduced.  The 
smaller  instruments  are  laid  on  a  sterile  towel  on  one 
of  the  tables  provided. 

Anesthesia. — It  is  always  advisable  that  the  anes- 
thetic be  administered  by  a  physician  called  in  for  that 
purpose,  as  the  nurse  is  greatly  needed  as  the  first 
assistant  to  the  operator,  but  it  sometimes  falls  to  the 
lot  of  the  nurse  to  give  the  anesthetic.  For  forceps 
operations  it  should  only  be  given  to  the  obstetrical 
degree,  the  patient  not  being  rendered  profoundly  un- 
conscious, but  the  keen  edge  of  the  pain  being  benumbed. 
The  anesthetic  is  given  either  upon  a  handkerchief  or 
an  Esmarch's  inhaler,  the  lips  and  nose  of  the  patient 
being  anointed  with  vaseline  to  prevent  the  chloroform 
from  burning.  It  is  very  important  that  the  room  be 
of  the  proper  temperature ;  but  it  must  be  remembered 
that  if  the  room  is  heated  by  gas  it  must  be  turned  out 
while  the  anesthetic  is  given,  especially  if  chloroform  is 
being  administered,  as  the  fumes  caused  by  these  two 
gases  cause  a  most  annoying  cough  in  all  who  are  in 


148 


Obst etrica I  N 1 1 rsing 


the  room.  The  chloroform  inhaler  should  be  removed 
from  the  face  when  the  anesthetic  is  renewed,  in  order 
not  to  drop  it  in  the  eyes.  If  ether  is  given  the  danger 
of  an  explosion  should  be  borne  in  mind,  and  illumi- 
nating or  heating  gas  or  lamps  must  not  be  near  the 
patient  and  anesthetist. 


FIG.  60.      BIVALVE  VAGINAL   SPECULUM. 

Forceps. — Two  kinds  of  forceps  are  in  general  use, 
those  with  solid  blades  and  the  fenestrated,  or  open 
blade.  Three  kinds  of  forceps  operations  are  performed 
— high,  median,  and  low. 

In  the  high  forceps  operation  the  child's  head  is 
above  the  brim  of  the  pelvis;  it  has  not  engaged.  This 
is  a  vovy  serious  and  difficult  operation,  and  is  usually 
done  with  a  special  instrument  called  the  axis  traction 
forceps. 


Obstetrical  Nursing 


149 


The  median  forceps  operation  is  done  upon  the  head 
which  has  engaged,  but  which  is  not  low  enough  to 
press  upon  the  perineum. 

In  the  low  forceps  operation  the  head  has  begun  to 
distend  the  perineum  but  shows  no  signs  of  advancement. 


FIG.  6l.      INSTRUMENT  TABLE  FOR  FORCEPS  OPERATION  AND 
POSSIBLE  PERINEORRHAPHY. 


Special  indications  for  the  application  of  forceps  are 
a  much  prolonged  second  stage  without  sign  of  advance- 
ment, exhaustion  of  the  mother  following  a  long  labor, 
signs  of  asphyxiation  of  the  child,  as  very  fast  or  quite 
slow  fetal  heart  sounds,  or  the  passage  of  meconium- 
stained  liquor  amnii  in  vertex  presentations. 


150 


Obstetrical  Nursing 


The  instruments  needed  for  a  forceps  delivery  are 
as  follows: 

Obstetrical  forceps. 

Soft  rubber  catheter. 

Four  artery  forceps. 

Two  volsellum  forceps. 

One  Sims'  speculum. 

One  perineal  retractor. 

One  pair  scissors. 

Two  perineal  needles. 

Half-dozen  silkworm  gut. 

Two  tubes  of  ten-day  chromicized  catgut. 

One  glass  douche  point. 

One  applicating  forceps,  long. 


FIG.  62.      FORCEPS  OPERATION. 


Obstetrical  Nursing 


151 


The  Operation. — The  forceps  operation  consists  in 
the  introduction  of  the  left  or  lower  blade,  with  the  left 
hand  of  the  operator  on  the  mother's  left  side ;  the  intro- 
duction of  the  upper  or  right  blade,  with  the  right  hand 
on  the  mother's  right  side,  and  the  adjustment  of  the 
blades  so  that  they  can  be  easily  brought  together  at  the 
shank  and  locked. 

After  traction  of  greater  or  less  severity  and  duration 
the  head  is  brought  down  on  the  perineum,  and  may  be 


FIG.  63.      MCLAIN  SOLID  BLADE  FORCEPS. 

delivered  spontaneously  or  with  the  blades  still  upon 
the  head. 

If  the  legs  are  held  by  the  sheet  sling  or  leg  holder 
the  nurse  stands  at  the  side  or  the  foot  of  the  table,  fac- 


FIG.  64.      ELLIOTT'S  FENESTRATED  BIADK  FORCEPS- 

ing  the  operator,  or  sits  upon  the  edge  of  the  bed  if  it 
is  a  bed  operation,  steadying  the  leg  with  one  hand,  and 
with  the  other  sponges  the  perineum  and  cleanses  the 
anus  if  the  advancing  head  forces  fecal  matter  out  in 
front  of  it.  As  the  head  advances  she  transfers  one 
hand  to  the  fundus,  causing  the  uterus  to  follow  down 


152  Obstetrical  Nursing 

after  the  body  of  the  child,  and  holds  the  other  in  readi- 
ness to  swab  out  the  mouth  and  wipe  the  eyes  as  soon  as 
it  is  born. 

The  rest  of  the  birth  and  the  duties  of  the  nurse 
incident  thereto  are  the  same  as  in  normal  deliveries. 

If  the  operation  has  been  upon  a  double  bed  the 
other  side  is  made  ready  for  the  patient,  and  as  soon 
as  she  has  been  cleansed  and  vulva  pad  adjusted  she 
is  quickly  moved  across  and  covered  with  sheet  and 
blanket,  the  fundus  being  held  meanwhile  to  keep  it 
contracted. 

Version. — This  is  an  operation  whereby  one 
presenting  part  of  the  child  is  substituted  for  another. 
When  the  feet  are  brought  down  it  is  called  a  podalic 
version;  when  the  presentation  is  changed  so  the  head 
is  born  first  it  is  a  cephalic  version.  One  of  the  chief 
indications  for  version  is  in  a  transverse  presentation, 
with  or  without  a  prolapse  of  the  hand  or  arm.  The 
operation  may  be  accomplished  either  by  external  means, 
by  the  internal  method,  or  by  a  combination  of  both. 
When  the  internal  method  is  used  the  operator's  hand 
and  forearm  are  thoroughly  sterilized,  or  better,  a  rubber 
gauntlet  glove  is  worn.  The  hand  is  introduced  into  the 
vagina  and  through  the  dilated  cervix  into  the  uterus. 
A  foot  is  then  grasped,  the  head  pushed  up  from  the 
pelvis,  usually  by  external  manipulation,  to  accomplish 
the  complete  turning.  After  the  feet  are  born  the  deliv- 
ery is  accomplished  as  in  an  ordinary  breech  presenta- 
tion. The  assistance  of  the  nurse  may  be  needed  as  the 
head  is  being  brought  down  in  the  pelvis,  to  exert  pres- 
sure downward  from  above  in  the  curve  of  Carus. 

The  greatest  dangers  in  podalic  version  are  rupture 
of  the  uterus  and  death  of  the  fetus  from  prolonged 
pressure  on  the  cord  by  the  after-coming  head. 


Obstetrical  Nursing  153 

Breech  Presentation. — This  presentation  is  not  very 
frequent,  and  usually  delays  labor  considerably,  especi- 
ally if  it  is  a  dry  labor.  In  much-prolonged  cases  assist- 
ance may  be  needed  in  order  to  save  the  child,  the  opera- 
tor introducing  a  sterilized  hand  in  the  uterus,  grasping 
a  foot,  and  making  traction  during  a  pain.  The  foot 
used  for  traction  is  usually  blue  and  swollen  for  a  day 
or  so  following  its  birth.  The  upriding  of  the  arms 
requires  very  quick  and  deft  treatment,  and  the  after- 
coming  head  may  cause  trouble.  The  child's  body  should 
be  enveloped  in  a  warm  wet  towel  as  soon  as  born,  in 
order  to  prevent  the  cold  air  causing  attempts  at  breath- 
ing before  the  mouth  is  born.  If  the  birth  of  the  head 
is  prolonged  more  than  five  minutes  after  the  birth  of 
the  body,  the  continued  pressure  on  the  cord  causes 
asphyxia  and  a  still  birth.  Delay  in  this  stage  may  be 
met  by  forceps  delivery  of  the  after-coming  head.  The 
perineum  is  very  often  lacerated  by  hurried  delivery  of 
the  head  in  order  to  save  the  baby. 

Symphysiotomy. — This  is  an  operation  in  which  the 
cartilage  between  the  two  pubic  bones  is  cut  through, 
allowing  the  symphysis  pubis  to  separate,  thus  enlarging 
the  inlet  of  the  pelvis  considerably.  In  the  after-care 
of  these  cases  the  patient  should  be  kept  on  a  specially 
devised  bed  by  which  pressure  is  made  on  the  sides  of 
the  pelvis,  to  bring  the  severed  bones  together,  holding 
them  firmly  to  enable  them  to  unite. 

Pubiotomy. — This  operation  has  practically  super- 
seded the  one  just  mentioned.  It  consists  in  sawing 
through  the  pubic  bone,  instead  of  cutting  through  the 
cartilage.  The  bone  is  cut  by  a  wire  saw,  called  the 
Gigli  saw,  and  when  divided  and  the  severed  ends  sepa- 
rated the  pelvis  is  enlarged  very  materially. 

The  delivery  is  completed  by  a  version  or  forceps. 


154  Obstetrical  Nursing 

The  after-care  is  of  importance — prevention  of  infection 
of  the  wound  from  the  vagina,  holding  the  pelvis 
together  to  insure  union  of  the  bones,  and  strapping 
the  knees  together  to  prevent  abduction  of  the  thighs. 

Cesarean  Section. — As  before  stated,  this  operation 
should  always  be  done  in  a  well-equipped  hospital,  as 
it  is  one  of  the  most  dangerous  to  both  mother  and  child. 
The  operation  consists  in  the  removal  of  the  child  and 
secundines  after  an  incision  through  the  abdominal 
wall  and  the  uterus.  It  is  indicated  where  it  is  impos- 
sible for  the  birth  to  take  place  via  the  natural  route 
because  of  contraction  of  the  pelvis,  an  abnormally 
large  child,  or  a  tumor  obstructing  the  passage.  If 
performed  early  in  labor,  before  the  mother  is  exhaust- 
ed, by  a  skilled  operator  and  in  ideal  surroundings, 
both  mother  and  child  may  be  saved. 

The  operation  is  performed  as  is  any  other  abdominal 
operation,  save  that  the  incision  is  longer.  The  uterus, 
as  soon  as  exposed,  is  either  held  at  the  cervix  by  an 
assistant  or  a  rubber  tourniquet  is  passed  around  it,  to 
control  the  hemorrhage ;  an  incision  is  made  in  the 
uterus,  and  if  the  placenta  is  inserted  on  the  anterior 
wall  it  is  cut  through  quickly  and  the  child  grasped 
and  delivered  through  the  opening;  the  cord  is  clamped 
and  cut,  and  the  child  given  at  once  to  an  assistant, 
who  endeavors  to  establish  respiration.  It  is  important 
that  there  be  a  tub  of  hot  water  at  hand  for  use  at  this 
time.  The  placenta  is  delivered  with  the  membranes, 
the  uterus  sewed  up,  the  peritoneum  and  abdominal  wall 
closed  as  in  any  other  operation,  and  the  after-care  is 
the  same  as  following  an  abdominal  section. 

"Written  orders  from  the  attending  surgeon  and 
obstetrician  must  be  had  by  the  nurse  as  to  nourishment, 
bladder,  bowels,  infant,  nursing,  etc. 


Obstetrical  Nursing  155 

Craniotomy. — This  operation  is  performed  to  lessen 
the  size  of  the  child's  head  in  cases  in  which  natural 
birth  is  impossible,  after  the  death  of  the  child.  If 
there  be  hope  of  saving  the  child's  life,  but  an  impos- 
sible natural  birth,  Cesarean  section  is  the  operation  of 
election. 

The  skull  is  perforated  by  a  special  instrument  de- 
vised for  the  purpose,  or  a  pair  of  blunt-pointed  scissors 
is  used.  The  opening  is  made  preferably  in  a  suture  or 
fontanelle,  if  within  reach,  and  the  instrument  is  carried 
into  the  skull  and  by  moving  it  about  the  brain  is  broken 
up.      A   crushing   instrument,    much   like   an   obstetric 


FIG.  65.      PERFORATOR  FOR  USE  IN  CRANIOTOMY. 

forceps,  is  introduced  and  applied  to  the  sides  of  the 
skull;  pressure  is  made,  and  the  brain  forced  out 
through  the  opening.  When  reduced  sufficiently  in 
size,  traction  is  made  and  the  head  delivered.  The 
mutilating  operations  are  most  severe,  and  test  the 
endurance  of  operator  and  assistants. 

Perineorrhaphy. — Careful  examination  should  be 
made  of  the  perineum  and  vagina  of  every  woman 
immediately  after  delivery,  to  ascertain  if  there  has 
been  a  laceration.  The  mucous  membrane  of  the  vagina 
is  always  swollen  and  there  are  minute  superficial  lacera- 
tions, but  when  these  extend  into  the  connective  tissue, 
muscle,  or  the  skin,  they  should  be  repaired  immediately. 
The  operation  when  performed  at  this  time  is  known  as 
a  primary  perineorrhaphy.     Silk,  silkworm  gut,  or  cat- 


156  Obstetrical  Nursing 

gut,  either  plain  or  chromicized,  may  be  used  to  secure 
apposition  of  the  torn  edges,  and  with  the  needles  and 
other  instruments  must  be  carefully  sterilized  by  boiling. 
The  catgut,  if  immersed  in  alcohol  in  sealed  tubes,  should 
be  boiled  before  using,  the  tube  held  in  a  sterile  towel 
and  broken  only  just  as  it  is  to  be  used. 

The  patient  is  brought  to  the  edge  of  the  bed  as 
for  a  forceps  operation,  or,  much  better,  placed  on  a 
table.  Usually,  unless  the  tear  is  very  extensive,  it  is 
not  necessary  to  administer  an  anesthetic,  as  the  parts 
are  numbed  and  partially  anesthetized  from  the  pressure 
at  the  time  of  the  birth  and  can  stand  the  few  needle 
pricks,  but  if  very  nervous  and  sensitive  an  anesthetic 
is  required.  The  possibility  of  a  hemorrhage  should  be 
borne  in  mind  following  the  administration  of  an 
anesthetic  at  this  time. 

The  after-care  of  these  patients  is  an  important  part 
of  the  treatment.  While  under  normal  conditions  a 
patient  can  be  allowed  to  assume  the  upright  position  to 
void  her  urine  and  for  bowel  evacuations,  she  should  be 
catheterized  the  first  day  or  so  after  the  perineorrhaphy 
and  use  the  bed-pan  for  bowel  movements.  If  the  tear 
has  been  complete,  involving  the  sphincter  ani  muscle, 
the  bowels  are  confined  for  three  or  four  days,  to  insure 
union  by  first  intention.  If  silkworm  gut  sutures  are 
used  their  removal  is  facilitated  by  using  perforated 
shot  for  holding  the  ends  together,  when  they  can  be 
cut  off  close  to  the  shot.  If  tied  and  the  ends  left  long, 
they  may  prick  the  skin  and  be  uncomfortable.  The 
long  ends  of  perineal  sutures  complicate  the  nursing 
of  the  case  very  much,  making  it  difficult  to  keep  the 
parts  cleansed. 

The  removal  of  catgut  sutures  is  not  necessary,  as 
they  are  absorbed;  silkworm  gut  is  usually  removed  at 


Obstetrical  Nursing  157 

the  end  of  a  week.  Tissue  forceps,  artery  forceps,  and 
a  sharp-pointed  scissors  are  needed,  and  should  be 
sterile.  The  patient  is  brought  down  to  the  edge  of  the 
bed  in  a  good  light,  the  ends  of  the  sutures  or  the  spot 
exposed,  and  only  one  end  cut  through,  the  loop  being 
then  withdrawn.  This  is  practically  painless,  and  the 
patient  may  be  assured  of  the  fact. 

Transfusion  is  performed  by  inserting  a  needle  into 
a  vein  and  introducing  into  it  a  quantity  of  normal  salt 
solution.  It  is  employed  after  severe  hemorrhages,  in 
sepsis,  and  in  eclampsia,  and  is  an  operation  which  has 
saved  many  lives.  Under  aseptic  precautions  one  of 
the  large  veins  of  the  arm  at  the  flexure  of  the  elbow  is 
exposed  by  an  incision  through  the  skin,  the  vein  having 
first  been  distended  by  pressure  applied  around  the  arm 
above  the  point  of  incision.  A  large  hypodermic  needle, 
attached  to  a  fountain  syringe  containing  sterile  salt 
solution  at  a  temperature  of  115°  F.,  is  then  inserted 
directly  into  the  vein,  a  pint  and  a  half  to  a  quart  of 
the  solution  being  allowed  to  run  directly  into  the  vein. 
The  salt  solution  is  prepared  by  dissolving  one  drachm 
of  salt  to  a  pint  of  water. 

Entero'clysis. — The  fluid  part  of  the  blood  may  also 
be  increased  by  enteroclysis — the  injection  of  water  into 
the  bowel.  If  allowed  to  run  in  with  any  force,  or  in 
large  quantity,  it  may  cause  peristalsis  and  be  expelled 
instead  of  retained,  as  desired.  If  an  artery  forceps  is 
placed  on  the  tube  leading  from  the  bag,  constricting  it 
so  the  water  drips  from  the  nozzle,  the  fluid  will  all  be 
absorbed  as  it  is  delivered  into  the  bowel.  The  solution 
in  the  bag  must  be  kept  at  an  even  temperature,  about 
95°  F. 

Vaginal  and  Uterine  Tampon. — In  cases  of  hem- 
orrhage it  may  be  necessary  to  pack  the  uterus  with 


158  Obstetrical  Nursing 

gauze  to  prevent  hemorrhage.  After  cleaning  out  the 
vagina  and  cervix  of  the  blood  clots,  the  patient  is 
brought  to  the  edge  of  the  bed  and  a  perineal  retractor 
or  Sims'  speculum  is  introduced  into  the  vagina.  The 
anterior  lip  of  the  cervix  is  grasped  by  a  volsella  forceps 
and  pulled  down  to  the  vulva.  With  a  pair  of  long 
dressing  forceps  gauze  which  has  been  folded  into  a 
narrow  strip  is  carried  to  the  fundus  and  the  uterus 
filled  with  it.  It  is  fed  to  the  operator  by  the  nurse 
from  a  sterile  towel  held  close  to  the  patient,  not  allow- 
ing it  to  touch  anything  as  it  is  introduced.  The  vagina 
is  then  packed  similarly  and  a  vulvar  protecting  dress- 
ing applied.  The  packing  is  usually  removed  at  the 
end  of  twenty-four  hours.  A  sterile  gauze  roller  band- 
age may  be  used  instead  of  the  folded  gauze. 

The  Douche. — A  douche  should  never  be  given  except 
upon  specific  and  written  directions  of  the  attending 
physician,  describing  the  character,  the  solution,  the 
amount,  the  temperature,  and  the  frequency.  An 
intra-uterine  douche  is  rarely  left  to  the  nurse  to  ad- 
minister. It  is  most  infrequent  that  a  vaginal  douche 
is  given  before  labor,  and  not  after  labor  unless  some 
special  indication  exists. 

The  strictest  aseptic  precautions  should  be  carried 
out  in  giving  a  vaginal  douche,  the  douche  point,  foun- 
tain syringe,  and  water  sterilized,  the  hands  carefully 
prepared,  and  the  labia  separated  before  introduction 
of  the  point.  The  temperature  of  the  solution  should  be 
taken  before  it  is  used.  If  a  primary  perineorrhaphy 
lias  been  done  the  point  of  the  nozzle  must  not  be  pressed 
against  the  perineum.  The  water  in  the  tube  is 
allowed  to  run  out,  as  it  is  cooler,  and  the  nozzle  is 
inserted  downward  and  backward,  the  bag  being  held 
about  two  Feet  above  the  bed,  and  about  a  quart  of  the 


Obstetrical  Nursing 


159 


solution  allowed  to  run  in.   A  douche-pan  is  much  better 
to  use  than  a  bed-pan  for  this  operation. 

Hypodermoclysis. — This  is  the  introduction  under 
the  skin,  in  the  cellular  tissue,  of  a  saline  solution.     A 


FIG.  66.      HYPODERMOCLYSIS. 

teaspoon  level  full  of  salt  is  dissolved  in  a  pint  of  water 
and  boiled  for  fifteen  minutes.  Because  of  the  loose 
tissue  under  the  breasts,  this  site  is  usually  selected 
for  the  transfusion.     The  skin  is  prepared  by  scrubbing 


160  Obstetrical  Nursing 

with  soap  and  water  followed  by  alcohol,  and  the  sterile 
needle,  attached  to  the  end  of  the  tube  leading  from  the 
fountain  syringe,  is  introduced  under  the  skin.  The 
bag  is  held  about  four  feet  above  the  patient,  and  from 
time  to  time  hot  saline  solution  is  added  in  order  to 
keep  it  at  about  110°  F.  As  soon  as  a  tumor  of  some 
size  is  formed  under  the  skin  the  needle  is  withdrawn 
and  reintroduced  in  another  place.  In  this  way  a  quart 
or  more  can  be  introduced  under  the  skin  without  taxing 
the  patient  at  all. 


FIG.  67.      COI.PEURYNTER. 

Induction  of  Premature  Labor. — A  number  of  indi- 
cations  for  the  induction  of  premature  labor  are  met 
with,  among  them  being  a  very  small  pelvis,  when 
induction  of  labor  before  full  time  makes  it  possible  to 
deliver  a  living  child  because  it  is  smaller;  eclampsia; 
placenta  previa;  death  of  the  fetus. 

The  method  to  be  employed  in  this  operation  is  de- 
termined largely  by  the  indications  present.  If  the 
patient  is  bleeding  from  a  placenta  previa,  immediate 
delivery  is  indicated,  and  the  cervix  must  be  forcibly 
dilated.     If  there  is  time  to  wait  on  Nature  a  catheter 


Obstetrical  Nursing  161 

can  be  introduced  through  the  cervix  into  the  uterus 
between  the  membranes  and  the  uterine  wall,  which  soon 
brings  on  uterine  contractions;  these  dilate  the  cervix, 
and  labor  progresses  to  the  completion  of  the  delivery. 
The  cervix  may  also  be  dilated  by  means  of  a  rubber 
bag;  one  type  of  bag  is  the  colpeurynter,  pear-shaped; 
the  other  is  the  Barnes'  bag.  The  latter  is  violin-shaped. 
Both  are  introduced  into  the  cervix  collapsed,  and  are 


FIG.  68.      BARNES'  BAGS. 

filled  with  water  slowly  injected  by  means  of  a  Davidson 
syringe  until  they  can  not  be  removed  without  trac- 
tion. As  soon  as  they  are  removed  a  larger  size  is 
introduced,  and  this  continued  until  labor  results. 

The  other  instruments  are  boiled  preparatory  to 
operating — two  Sims'  and  one  bivalve  speculum,  two 
pair  volsellum  forceps,  one  long  dressing  forceps, 
scissors,  soft  rubber  flexible  catheter,  and  the  rubber 
bags  just  described. 

The  patient  is  placed  on  a  table  in  the  Sims '  position, 
or  preferably  in  the  lithotomy  position,  and  the  vulva 
prepared   as   for   any   other   surgical   procedure.      The 


162  Obstetrical  Nursing 

speculum  is  introduced,  the  cervix  exposed,  the  anterior 
lip  is  grasped  by  the  volsellum  forceps,  and  moderate 
traction  made.  The  vagina  is  cleansed  by  a  douche  and 
by  sponging  before  the  bag  or  catheter  is  introduced. 
The  nearer  full  term  the  easier  will  be  the  dilatation  of 
the  cervix  to  sufficient  size  to  permit  the  introduction 
of  the  bags. 


FIG.  69.      VOLSEHUM  FORCEPS. 

If  just  prior  to  full  term,  and  immediate  delivery 
is  necessary,  the  cervical  dilation  may  be  accomplished 
by  the  fingers. 

A  record  is  kept  by  the  nurse  upon  the  history  sheet 
of  the  character  of  interference  and  of  the  first  labor 
pains. 


CHAPTER  IX. 

Obstetric  Complications. 

COMPLICATIONS  OF  PREGNANCY. 

Pregnancy  is  a  normal  physiological  condition,  and 
should  proceed  throughout  the  entire  period  of  gesta- 
tion without  trouble.  A  pregnant  woman,  however,  is 
prone  to  develop  many  intercurrent  troubles  as  the 
result  of  her  condition,  and  especially  if  a  primipara 
serious  symptoms  may  be  present  and  be  considered  a 
natural  consequence  of  the  pregnancy,  which  if  report- 
ed and  the  proper  treatment  instituted  would  prevent 
severe  and  perhaps  fatal  complications.  Hence,  every 
pregnant  woman  should  very  soon  after  recognizing 
her  condition  place  herself  under  the  care  of  the  physi- 
cian whom  she  has  selected  to  be  with  her  at  her  con- 
finement, and  report  regularly  to  him. 

Nausea  and  Vomiting. — This  is  one  of  the  most  fre- 
quent symptoms  of  pregnancy,  and  several  forms  are 
described.  There  may  be  nausea  on  awakening  in  the 
morning,  the  so-called  "morning  sickness,"  without 
vomiting,  a  more  severe  form  in  which  nausea  is  present 
most  of  the  time,  with  every  day  or  so  vomiting  of 
a  meal,  usually  breakfast;  and  pernicious  vomiting  or 
hyperemesis  gravidarum.  In  this  form  the  patient 
vomits  constantly,  and  rapidly  sinks  into  a  typhoid  or 
very  low  state,  with  her  life  endangered. 

The  causes  of  this  condition  have  never  been  definite- 
ly determined,  but  the  consensus  of  opinion  is  that  it 
is  due  to  a  toxemia  of  the  system,  a  failure  to  throw  off 
the  products  of  tissue  waste,  their  retention  causing 
this  symptom.     Reflex  irritation  has  also  been  ascribed 


164  Obstetrical  Nursing 

a  cause,  as  a  malposition  of  the  uterus  or  a  congestion 
or  inflammation  of  the  cervix  uteri. 

The  treatment  of  morning  sickness  may  not  be  at  all 
effective,  a  large  number  of  drugs  having  been  suggested, 
none  of  which  is  a  specific.  Taking  a  small  breakfast 
in  the  early  morning  in  the  recumbent  position,  and 
lying  quiet  with  head  low  for  two  hours  following,  and 
gradually  arising  and  slowly  dressing,  often  prevents 
vomiting.  Attention  to  the  bowels  is  most  important; 
saline  cathartics,  cascara,  enemata,  or  suppositories  may 
be  used.  Small  meals  of  easily  digested  food  at  short 
intervals  are  also  advisable.  Large,  heavy  meals  usually 
aggravate  the  condition.  The  correction  of  local  pelvic 
abnormalities  is  always  desirable. 

In  pernicious  vomiting  the  treatment  may  be  entirely 
unavailing;  the  vomiting  becomes  almost  continuous, 
often  of  blood ;  fever  develops ;  rapid  pulse ;  prostration ; 
loss  of  weight  and  strength.  Stomach  washing  is  often 
very  beneficial,  with  high,  stimulating  enemata. 

Odors  of  cooking  should  not  be  allowed  to  reach  the 
patient,  and  she  should  not  be  consulted  in  regard  to  her 
diet.    Daintily  prepared  trays,  with  small  portions,  fre 
quently  will  tempt  her  and  assist  in  their  retention. 

The  typhoid  state  developing  or  threatening,  pre- 
mature labor  is  induced  and  the  product  of  conception 
expelled  in  order  to  save  the  patient's  life,  but  only 
after  a  careful  consultation  Avith  one  or  more  physicians. 

Induction  of  abortion  having  been  determined  on, 
the  patient  is  prepared  for  a  major  operation  as  de- 
scribed elsewhere. 

Nursing  after  an  abortion  in  pernicious  vomiting  is  a 
most  important  feature  of  the  case.  Rectal  feeding  is 
often  necessary  at  first.  It  must  be  borne  in  mind  that 
the  rectum  is  an  absorbing  organ,  and  not  a  digesting 


Obstetrical  Nursing 


165 


one,  and  food  introduced  in  this  way  must  be  in  small 
quantities  and  predigested. 

Quiet,  prolonged  rest  in  bed,  a  liberal  amount  of 
water — if  necessary  by  hypodermoclysis  at  first — and 
concentrated  nourishment,  will  yield  the  best  results. 

Eclampsia. — In  this  condition  convulsions  occur  and 
may  be  present  during  the  latter  weeks  of  pregnancy, 
during  or  after  labor. 


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FIG.  70.      ECLAMPSIA. 

The  cause  of  eclampsia  is  similar  to  that  of  the 
vomiting  of  pregnancy  in  all  of  its  forms,  namely,  a 
toxemia,  a  retention  in  the  blood  of  toxins,  the  products 
of  tissue  waste,  with  perhaps  some  vicious  changes  in 
the  liver  due  to  the  pregnancy. 

A  condition,  known  as  the  pre-eclamptic  stage,  is 
usually  present,  which  is  a  warning  of  the  danger  of 
the  development  of  the  severe  and  serious  eclampsia. 
Among  the  symptoms  of  the  pre-eclamptic  stage  are 
the  following :  headache ;  dizziness ;  disturbances  of 
vision,  as  black  specks  before  the  eyes,  and  blindness; 


166  Obstetrical  Nursing 

return  of  the  nausea  and  vomiting ;  constipation ;  edema 
of  the  feet  and  legs;  scanty  and  albuminous  urine,  and 
loss  of  appetite. 

Albumen  in  the  urine  during  pregnancy  is  always  a 
danger  sign,  and  the  patient  so  affected  should  be 
watched  very  closely,  her  diet  restricted  to  milk,  active 
purgation  obtained,  together  with  quiet  and  protection 
of  the  body  from  chilling. 

In  acute  eclampsia  the  patient  is  in  active  convul- 
sions. They  begin  with  twitching  of  the  muscles  of 
the  face  and  eyes,  quickly  becoming  general.  There  is 
cyanosis,  stertorous  breathing,  foam  at  the  mouth,  which 
may  be  blood  tinged  if  the  tongue  is  bitten.  The  active 
convulsions  last  a  varying  length  of  time  and  the 
patient  relaxes  and  consciousness  gradually  returns,  or 
she  lapses  into  a  profound  coma  with  sooner  or  later  a 
return  of  the  convulsions. 

The  prognosis  is  influenced  largely  by  the  length, 
severity,  and  frequency  of  the  convulsions  and  the 
depth  of  the  coma  between. 

An  excess  of  liquor  amnii,  hydramnios,  and  multiple 
pregnancy,  especially  in  primi parse,  are  frequently 
associated  with  eclampsia. 

The  treatment  of  eclampsia  may  be  divided  into, 
(1)  control  of  the  convulsions  and  protection  of  the 
patient  from  injury;  (2)  emptying  the  uterus  in  the 
quickest  way  that  will  do  the  least  violence  and  injury 
to  the  mother;  (3)  elimination  of  the  toxic  products  in 
the  blood. 

Place  a  folded  handkerchief  or  napkin  or  a  wrapped 
clothespin  between  the  teeth,  to  prevent  the  protrusion 
and  biting  of  the  tongue.  See  that  the  patient  does  not 
fall  out  of  bed.  (1)  Control  the  convulsions  with  (a) 
chloroform,  (b)  veratrum  viridi  (twenty  minims  injected 


Obstetrical  Nursing  167 

subcutaneously  at  half  or  hourly  intervals  until  the  pulse 
reaches  60),  (c)  bromide  and  chloral  (per  rectum),  and 
(d)  morphine;  (2)  artificial  dilatation  of  the  cervix, 
with  delivery  of  the  child  by  version  or  forceps;  (3) 
elimination  by  saline  cathartics,  high  enemata,  hot  wet 
packs,  and  by  hypodermoclysis. 

Varicose  Veins. — Enlargement  of  the  veins  of  the 
extremities  and  of  the  vulva  frequently  occur,  especially 
in  multipara?.  On  the  legs,  these  veins  may  be  ruptured 
by  striking  them  against  a  sharp  object,  and  a  severe 
hemorrhage  result.  A  flannel  roller  bandage,  an  elastic 
stocking  made  to  fit  by  measure,  or  adhesive  strips,  will 
usually  give  the  needed  support  to  the  vessel  walls  and 
great  comfort  to  the  patient.  If  of  the  vulva,  the  wear- 
ing of  a  wide  vulvar  pad,  quite  snugly  fitted,  Avill  usually 
give  great  comfort. 

If  the  vessel  should  be  ruptured  in  the  leg,  a  tourni- 
quet or  bandage  should  be  applied  at  once  below  the 
wound  and  the  physician  notified. 

Encircling  garters  should  not  be  worn  during  the 
latter  months  of  pregnancy. 

Pruritus. — Itching  of  the  vulva  is  often  present  late 
in  pregnancy,  and  is  usually  associated  with  varicosities 
of  the  vulva,  or  leucorrhea,  or  both. 

Local  external  applications,  as  a  1  to  40  or  60 
carbolic  solution,  bicarbonate  of  soda  in  saturated 
solution,  carbolated  vaseline  and  menthol,  may  give 
relief.  Irritating  discharges  should  receive  proper 
treatment  at  the  hands  of  the  physician.  Douches  be- 
fore labor  must  always  be  given  with  extreme  caution, 
and  only  on  the  physician's  orders. 

Inability  to  be  on  the  feet  because  of  pressure 
symptoms,  late  in  pregnancy,  will  be  greatly  relieved  by 
the  wearing  of  an  abdominal  supporter  from  the  seventh 


168  Obstetrical  Nursing 

month.  This  holds  the  uterus,  which  has  a  tendency  to 
fall  forward,  and  distributes  the  weight  evenly  on- the 
muscles  of  the  back.  The  supporter  is  also  a  great  relief 
when  there  is  pressure  upon  the  neck  of  the  bladder, 
associated  with  a  frequent  desire  to  urinate,  which 
occurs  during  the  last  weeks. 

Hemorrhages. — Bleeding  from  the  vagina  may  occur 
at  any  time  during  pregnancy.  When  it  is  associated 
with  pain  in  the  abdomen  during  the  early  months  of 
gestation  it  indicates  a  threatened  abortion  and  calls 
for  careful  nursing.  Hemorrhage  may  arise  from  the 
cervix,  from  a  small  tumor,  or  from  a  prematurely  de- 
tached placenta.  When  occurring  late  in  pregnancy 
it  indicates  a  placenta  previa.  In  this  condition  the 
placenta  is  attached  over  the  internal  os,  the  edge,  the 
margin,  or  the  entire  cervix  being  covered.  The  great- 
est risk  in  this  condition  is  to  the  mother,  though  the 
child  may  also  die  because  of  the  lessening  of  the  area 
of  the  attachment  of  the  placenta  and  the  decrease  in 
the  amount  of  oxygen  it  receives  in  consequence. 

Patients  in  the  last  weeks  of  pregnancy  who  have  the 
slightest  hemorrhage  should  be  kept  under  the  closest 
observation,  and  the  physician  notified  the  moment  any 
change  occurs.  They  should  be  kept  in  bed  continu- 
ously. 

Extra-uterine  Pregnancy. — A  fecundated  ovum  may 
find  lodgment  in  the  abdomen  and  continue  to  develop 
to  full  term,  or,  as  is  usually  the  case,  the  child  dies 
before  the  end  of  gestation.  If  it  lodges  in  the  Fal- 
lopian tube  it  is  called  a  tubal  pregnancy.  The  tube 
will  permit  of  stretching  to  a  very  moderate  extent,  and 
at  from  four  to  six  weeks  rupture  of  the  tube  occurs, 
followed  by  a  more  or  less  severe  hemorrhage  into  the 
abdominal  cavity. 


Obstetrical  Nursing  169 

Symptoms.  The  early  symptoms  of  tubal  pregnancy 
are  similar  to  a  normal  uterine  pregnancy,  except  the 
menstrual  history  may  be  erratic,  slight  continuous  or 
irregular  flow,  with  passage  of  membranous  shreds.  If 
she  is  examined  at  this  time  a  tumor  can  be  felt  to  the 
side  of  the  uterus.  When  rupture  occurs  there  is  great 
pain  upon  the  affected  side,  attended  with  more  or  less 
profound  shock.  The  latter  is  due  to  the  hemorrhage, 
which  occurs  simultaneously.  There  is  pallor,  faintness, 
nausea,  shallow  respiration,  with  rapid,  thready,  and 
weak  pulse.  Immediate  operation,  tying  the  bleeding 
vessels  and  removing  the  blood  clots  and  fetus,  may  save 
the  patient. 

COMPLICATIONS  OF  LABOR. 

Not  infrequently  in  multiparae  the  labor  is  short  and 
the  child  may  be  born  before  the  physician's  arrival, 
in  which  event  the  nurse  must  perform  her  duties  to  the 
best  of  her  ability.  She  should  maintain  a  cool  de- 
meanor, showing  no  excitement.  In  all  cities  a  large 
number  of  women  are  delivered  by  midwives,  who  have 
had  nothing  but  a  practical  bedside  training,  with  no 
knowledge  of  the  refinements  of  aseptic  midwifery; 
hence,  a  trained  nurse  should  be  able  to  conduct  a  normal 
delivery  with  much  greater  safety  to  both  mother  and 
child. 

Let  Nature  take  its  course  unmolested  until  the 
perineal  stage  is  reached,  when  unusual  watchfulness 
should  be  exercised.  Ask  the  patient  not  to  bear  down, 
if  it  is  possible  for  her  to  refrain  from  doing  so,  just  at 
this  time,  letting  the  contractions  of  the  uterus  accom- 
plish the  stretching  of  the  perineum  gradually.  When 
the  head  is  distending  the  perineum  open  the  right  hand 
and  grasp  the  sides  of  the  head  with  the  thumb  and  index 


170  Obstetrical  Nursing 

finger,  exerting  pressure  to  prevent  the  too  rapid  escape 
of  the  head  through  the  distending  vulva.  If  the  head  is 
born  too  rapidly  the  perineum  will  be  torn;  if  the  pres- 
sure just  described  is  exercised  the  perineum  will  be 
supported  and  tearing  probably  prevented. 

As  soon  as  the  head  is  born  the  fingers  should  feel 
for  the  cord,  to  ascertain  if  it  is  around  the  neck;  if  it 
is,  it  should  be  pulled  over  the  head,  in  order  to  prevent 
too  great  traction  being  made  on  the  placenta. 

The  child's  mouth  should  then  be  wiped  out,  to  pre- 
vent the  inspiration  of  mucus  into  the  lungs.  When  the 
cord  has  ceased  pulsating  about  eight  inches  from  its  in- 
sertion in  the  abdominal  wall,  it  should  be  tightly  tied 
in  two  places,  the  nearest  ligature  two  inches  from  the 
wall,  and  the  cord  severed  between  these  ligatures.  The 
nurse  should  see  to  it  that  the  fundus  is  held  by  some 
one,  in  order  to  be  sure  the  uterus  remains  well  con- 
tracted. 

It  not  infrequently  happens  that  a  nurse  has  the 
entire  conduct  of  the  case  throughout,  and  she  should 
be  prepared  for  the  emergency.  Keep  the  hand  on  the 
fundus,  rubbing  it  gently  whenever  it  is  felt  to  relax, 
waiting  for  the  uterine  efforts  unaided  to  complete  the 
third  stage.  If  the  placenta  presents  it  should  be  caught 
in  the  free  hand,  and  as  the  membranes  appear  at  the 
vulva,  rotate  or  twist  the  placenta  without  making  any 
traction,  so  the  membranes  will  form  a  rope,  and  they 
will  gradually  escape  intact. 

If  the  nurse  has  had  the  entire  conduct  of  the  labor 
the  placenta  should  be  saved  for  close  inspection  by  the 
physician. 

Breech  Presentation. — Should  the  child  present  by 
the  breech,  if  it  is  unusually  large  there1  is  apt  to  be 
trouble  if  it  is  born  too  quickly.     As  it  is  forced  down, 


Obstetrical  Nursing  171 

the  arms,  normally  crossed  over  the  chest,  are  caught  on 
the  pelvis  and  made  to  upride  alongside  the  head.  This 
makes  the  diameter  so  great  as  to  prevent  further  prog- 
ress until  the  arms  have  been  brought  down,  which  is 
ordinarily  quite  a  difficult  procedure.  As  the  body  is 
born  it  should  turn  with  its  back  pointing  upward,  to 
facilitate  the  birth  of  the  after-coming  head. 

As  the  head  is  born  the  child  is  supported  by  its  feet 
and  carried  in  a  circle  upward  toward  the  mother's 
abdomen.  With  the  mouth  born,  the  child  can  inspire 
without  danger  of  aspirating  mucus  and  liquor  amnii 
into  the  lungs.  As  soon  as  the  air  strikes  the  skin  of  the 
body  the  child  can  be  seen  to  make  several  inspiratory 
efforts. 

Postpartum  Hemorrhage. — No  complication  before, 
during,  or  after  labor  is  so  trying,  or  requires  such 
prompt  action,  as  hemorrhage  following  labor.  It  may 
occur  very  quickly,  and  the  volume  of  blood  lost  be 
so  great  as  to  endanger  the  patient's  life  before  remedial 
measures  can  be  instituted.  The  bleeding  may  occur 
from  the  placental  site  or  from  a  severe  laceration  of 
some  portion  of  the  genital  tract,  usually  either  the 
cervix  or  the  floor  of  the  vagina.  When  the  hemorrhage 
occurs  during  the  first  hour  after  labor  it  is  called  a 
primary,  after  this  time  a  secondary,  hemorrhage. 

Sy?nptoms. — The  first  symptom  may  be  the  request 
of  the  patient  for  more  air,  to  have  the  windows  opened, 
or  of  faintness  or  dizziness.  The  first  glance  at 
her  face  will  show  pallor,  blanched  lips,  with  perhaps  a 
cold  perspiration.  The  respiration  is  quick  and  shallowT, 
the  pulse  feeble  and  rapid,  and  she  may  faint.  Unless 
the  bleeding  is  controlled  a  fatal  termination  will  be 
speedy. 

The  physician  is  usually  present  to  combat  the  pri- 


172  Obstetrical  Nursing 

mary  hemorrhage,  but  the  nurse  must  be  prepared  to 
cope  with  a  secondary  hemorrhage,  for  there  will  -not 
be  time  to  summon  assistance  if  the  mother's  life  is  to 
be  saved. 

The  nurse  should  count  the  mother's  pulse  at  fre- 
quent intervals,  and  inspect  the  vulval  dressing.  If  the 
pulse  is  over  100  and  the  pad  is  soiled  through  suffi- 
ciently to  require  changing  as  often  as  every  fifteen 
minutes,  the  bleeding  is  too  profuse.  Not  only  the  pad 
covering  the  vulva  should  be  inspected,  but  that  portion 
under  the  buttocks  looked  at  also,  as  the  blood  may  not 
be  absorbed  by  the  pad  as  it  escapes. 

Treatment. — Preventive  treatment  is  most  important. 
The  fundus  should  be  held  from  the  time  the  head  is 
distending  the  perineum,  to  insure  uterine  contraction 
upon  the  body  as  it  emerges.  This  should  be  continued 
for  an  hour.  It  is  especially  important  in  protracted 
labors  and  after  anesthesia  for  operative  deliveries,  as 
a  tired  and  relaxed  uterus  does  not  contract  readily. 

As  soon  as  a  hemorrhage  begins,  the  fundus  of  the 
uterus  must  be  located,  vigorously  rubbed  to  insure  con- 
traction, firmly  grasped  by  the  open  hand  and  pressed 
backward  against  the  sacrum.  This  will  usually  expel 
some  clots  from  the  vagina,  with  fluid  blood.  A  hot 
vaginal  douche,  120°  F.,  can  be  given  at  this  time.  The 
bleeding  continuing,  the  vagina  can  be  packed  with 
sterile  gauze,  the  foot  of  the  bed  raised,  and  a  teaspoonful 
of  the  fluid  extract  of  ergot  given  by  the  mouth,  or 
twenty  minims  of  aseptic  ergot  hypodermatically. 

While  these  ministrations  are  being  carried  on,  the 
nurse  instructs  the  onlookers  in  regard  to  the  prepara- 
tion of  sterile  solutions  for  the  physician's  use. 

The  nursing  of  a  patient  following  a  hemorrhage  is 
important.     Fluids  should  be  given  freely,  in  fact  the 


Obstetrical  Nursing  173 

diet  should  be  liquid  for  the  first  few  days.  Enteroclysis 
is  of  great  benefit.  Absolute  quiet  should  be  insisted  on, 
and  the  patient  not  allowed  to  help  herself  at  all  for 
several  days. 

COMPLICATIONS  OF  THE  PUERPERIUM. 

Puerperal  Infection. — Since  our  Oliver  Wendell 
Holmes  proved  that  puerperal  fever  is  a  preventable 
disease,  and  due  to  the  introduction  of  bacteria  from 
without,  thousands  of  women  have  been  saved  to  their 
families.  A  normal  puerperium  is  afebrile,  and  the 
most  frequent  cause  of  fever  at  this  time  is  an  infection. 
Not  only  can  the  infecting  septic  material  be  introduced 
in  the  parturient  tract  before  labor,  but  during  and  after 
labor  as  well.  There  are  many  minute  abrasions  in  the 
mucous  membrane  as  the  result  of  the  traumatism  of  the 
labor,  with  absorbing  lymphatics  exposed,  hence  the 
absolute  necessity  for  the  strictest  surgical  cleanliness 
of  patient,  physician,  nurse,  vessels,  instruments,  and 
dressings. 

A  physician  does  not  attend  a  confinement  case  while 
in  attendance  upon  the  contagious  diseases.  The  nurse 
should  so  time  her  engagements  that  she  does  not  go  to 
a  labor  from  a  patient  with  a  contagious  disease,  or  a 
case  of  sepsis. 

There  can  be  no  such  occurrence  as  a  woman  infect- 
ing herself  from  organisms  already  in  the  system ;  the 
offending  organisms  are  carried  there  on  the  examining 
fingers,  on  instruments,  or  from  manipulations  during 
the  dressings  after  labor.  The  developing  organisms 
find  in  the  abrasions  throughout  the  genital  tract  open- 
mouthed  vessels,  which  absorb  either  the  bacteria  them- 
selves or  their  products,  the  toxins.  There  are  two  kinds 
of  infection,  one  a  sapremia,  where  there  is  retained  in 


174  Obstetrical  Nursing 

the  uterus  or  vagina  a  piece  of  afterbirth  or  a  decom- 
posing blood-clot,  to  which  is  carried  an  offending 
organism;  the  result  of  the  absorption  of  the  product  of 
this  decomposing  mass  is  a  septic  condition,  relieved  by 
the  removal  of  the  offending  material.  The  other  is  an 
infection  from  the  direct  invasion  of  the  pelvic  organs 
by  septic  organisms,  their  development  there  and  the 
absorption  into  the  circulation  of  their  toxins,  causing 
septicemia  or  "blood-poisoning." 

The  chief  treatment  of  sepsis  or  sapremia  is  that 
of  prevention,  and  too  great  care  can  not  be  exercised 
in  observing  the  strictest  cleanliness  about  a  woman  in 
labor  and  during  the  puerperium,  most  carefully  steril- 
izing the  hands,  instruments,  dressings,  and  everything 
which  may  come  in  contact  with  her  genital  tract. 

The  symptoms  of  sepsis  generally  manifest  them- 
selves between  the  third  and  seventh  days,  rarely  later 
than  the  seventh  day.  There  is  usually  a  chill  or  a  rigor, 
headache,  pain  perhaps  in  the  pelvis,  a  temperature 
ranging  from  101°  F.,  and  a  pulse  rate  always  con- 
siderably over  a  hundred. 

The  nursing  in  sepsis  is  a  most  important  part  in  its 
treatment,  the  ultimate  result  depending  to  a  great  ex- 
tent on  the  care  the  patient  receives.  She  requires  the 
most  careful  feeding,  judicious  stimulation,  and  absolute 
rest,  the  directions  of  the  attending  physician  being  most 
carefully  recorded  and  followed.  Her  nourishment  is 
generally  of  a  fluid  character;  milk,  eggs,  and  broths 
should  be  given  in  small  quantities  at  regular  intervals. 
Her  stimulation,  which  may  be  both  hypodermatically 
and  by  the  mouth,  must  be  given  with  great  regularity. 

Locally  the  application  of  an  ice-bag  over  the 
abdomen  may  be  required  at  the  point  of  greatest  pain 
and  tenderness,  and  frequent  hot  vaginal  douches  may 


Obstetrical  Nursing  175 

be  ordered.  These  should  be  carefully  administered, 
never  less  than  a  quart  in  amount,  and  of  the  proper 
temperature.  Should  an  intra-uterine  douche  be  re- 
quired, it  should  be  administered  by  the  physician. 

Should  the  trouble  be  entirely  local,  confined  to  the 
uterine  cavity,  the  offending  material — pieces  of  placenta 
or  membrane — being  retained,  a  currettage  may  be  neces- 
sary to  remove  the  mass.  The  patient  is  prepared  for 
this  operation  as  for  a  forceps  delivery,  in  like  position, 
with  an  ample  supply  of  irrigation  water. 

Hypodermoclysis  or  enteroclysis  are  frequently  used 
with  excellent  results. 

The  after-care  is  important.  Concentrated  nourish- 
ment is  continued,  the  patient  allowed  to  resume  the 
upright  position  very  slowly.  She  should  not  be  allowed 
to  nurse  the  baby,  and  no  special  effort  made  to  con- 
tinue the  supply  of  milk. 

Too  great  care  can  not  be  exercised  by  the  nurse,  in 
leaving  a  case  of  this  nature,  in  carefully  sterilizing 
her  person  and  clothes  before  accepting  another  obstet- 
rical case. 

After-pains. — These  are  caused  by  the  contractions 
of  the  uterus  following  labor;  after  each  successive  de- 
livery they  become  more  severe.  Primiparae  do  not 
suffer  greatly  from  after-pains,  but  they  are  apt  to  be 
quite  severe  in  multiparas.  They  are  due  to  the  uterus 
contracting  to  expel  a  blood-clot  or  shred  of  membrane 
or  placenta.  They  may  only  occur  when  the  child  is  put 
to  the  breast.  Rubbing  the  uterus  with  slight  pressure 
may  relieve  the  condition  temporarily.  It  may  be  neces- 
sary to  administer  a  sedative — a  small  dose  of  heroin  or 
morphine. 

Phlegmasia  Alba  Dolens. — An  infection  from  the 
uterus   extending  to  the  veins  of  the  pelvis   or  thigh 


176  Obstetrical  Nursing 

causes  a  phlebitis,  an  inflammation  of  the  vein,  with 
resulting  swelling  sufficient  to  obliterate  the  vessel 
entirely.  This  causes  a  swelling  of  the  leg,  sometimes 
to  enormous  proportions — the  so-called  ' '  milk  leg. ' '  The 
same  condition  may  occur  in  any  patient,  complicating 
other  diseases,  as  septicemia,  pneumonia,  etc.,  hence  it 
has  no  connection  with  the  appearance  of  milk  in  the 
breasts. 

There  is  fever,  pain,  and  tenderness  at  the  site  of 
the  inflammation  and  often  through  the  entire  leg,  and 
the  skin  is  tense  from  the  swelling.  Absolute  rest  and 
quiet  of  the  limb  is  essential.  It  should  not  be  rubbed 
or  massaged,  as  a  blood-clot  may  be  dislodged  and  an 
embolism  caused  which  would  be  caught  in  the  blood- 
current  and  carried  to  the  heart,  lungs,  or  brain.  The 
entire  limb  should  be  wrapped  in  flannel  and  cotton, 
slightly  elevated  on  pillows,  and  not  moved  by  the 
patient  at  all. 

Bladder. — Owing  to  the  relief  of  pressure  and  tension 
with  the  expulsion  of  the  uterine  contents,  and  the  con- 
sequent lax  condition  of  the  abdominal  walls,  the  bladder 
becomes  easily  distended  with  urine,  and  often  to  a  dan- 
gerous degree  without  causing  great  discomfort.  Under 
such  circumstances  the  patient  may  pass  a  small 
quantity,  the  overflow,  and  leave  a  large  amount  in  the 
bladder,  which  will  decompose  and  cause  an  inflammation 
of  the  mucous  membrane  of  the  bladder. 

If  the  fundus  of  the  uterus,  at  the  end  of  the  first 
^venty-four  or  thirty-six  hours,  is  found  at  or  above  the 
umbilicus,  distention  of  the  bladder  should  be  suspected, 
and  inspection  of  the  abdominal  wall  will  usually  show 
the  distended  bladder  as  a  distinct  tumor.  Catheter- 
ization, under  these  conditions,  is  always  indicated. 

Cystitis  may  result  from  an  infection  from  the  bowel 


Obstetrical  Nursing  111 

by  the  colon  bacillus,  a  decomposition  of  the  residual 
urine,  or  follow  a  faulty  catheterization.  It  is  asso- 
ciated with  a  rise  in  temperature,  pain,  a  sense  of  weight 
and  pressure  in  the  bladder,  a  frequent  desire  to  urinate, 
with  great  pain  as  the  last  few  drops  are  passed.  Al- 
bumen, pus,  and  often  blood  are  found  in  the  urine. 

The  treatment  consists  in  the  administration  of  a 
urinary  antiseptic  internally,  and  if  the  symptoms  so 
indicate  irrigation  of  the  bladder  must  be  done.  This 
is  done  through  a  catheter,  the  urine  being  allowed  to 
first  escape.  The  small  point  of  a  fountain  syringe, 
connected  with  a  rubber  tube  and  funnel,  is  then  attached 
to  the  catheter  and  a  warm  solution  of  boracic  acid 
poured  in.  Care  is  taken  not  to  overdistend  the  bladder. 
The  solution  is  then  siphoned  out  and  fresh  solution  in- 
troduced as  often  as  thought  advisable. 

Pyelitis. — This  is  an  infection  of  the  pelvis  of  the 
kidney  by  the  colon  bacillus.  This  organism  can  gain 
entrance  to  the  kidney  by  the  blood,  through  the  lym- 
phatics, or  travel  up  from  the  bladder  through  the  ureter. 

The  symptoms  may  be  very  obscure,  perhaps  an  ir- 
regular, widely  varying  temperature,  with  rigors  and 
sweats,  being  the  only  ones  present.  Pain  or  tenderness 
over  the  loins  may  be  found.  The  diagnosis  may  not  be 
made  until  the  urine  is  examined  both  chemically  and 
microscopically.  Albumen,  pus,  and  blood,  with  a  very 
motile  bacteria,  are  found. 

A  catheterized  specimen  should  always  be  obtained 
for  examination,  in  order  not  to  have  it  contaminated  by 
the  lochia.  A  urinary  antiseptic  will  usually  result  in 
a  cure. 

Constipation. — Because  of  the  lax  abdominal  walls, 
and  a  temporary  interference  with  the  nerve  supply  of 
the  bowels  following  labor,  tympanites  may  develop  from 


178  Obstetrical  Nursing 

an  accumulation  of  gas  in  the  intestines.  This  gas 
formation  occurs  usually  about  the  third  or  fourth  day. 
Constipation  is  the  rule  following  delivery.  The  admin- 
istration of  a  half  ounce  of  castor  oil  on  the  second  or 
third  day  yields  excellent  results,  and  no  other  laxative 
is  as  efficacious.  Daily  enemata  or  suppositories  are  nec- 
essary as  a  rule  until' the  patient  is  able  to  sit  up.  The 
use  of  the  commode  after  the  first  day,  if  the  perineum 
is  not  torn,  is  a  great  assistance  in  overcoming  this 
tendency  to  constipation.  Impaction  of  the  rectum  may 
be  present  and  is  overcome  by  injections  of  saline  solu- 
tion, glycerine,  olive  oil,  or  a  solution  of  ox-gall  and  glyc- 
erine, each  one  drachm  and  water  enough  to  make  a  quart, 

The  use  of  cascara  is  indicated,  but  the  possibility  of 
its  being  excreted  through  the  breast  and  thus  affect  the 
child  should  be  borne  in  mind. 

Mastitis. — An  inflammation  of  the  breast.  An 
infection  takes  place  through  a  minute  abrasion  or  a 
crack  or  fissure  in  the  nipple,  with  an  acute  inflammation 
resulting,  with  or  without  the  formation  of  pus — an 
abscess. 

The  prevention  of  a  mastitis  is  most  important.  The 
strictest  asepsis  should  be  maintained  in  every  case  of 
fissured  nipple,  in  order  to  prevent  absorption  of  pus- 
producing  organisms  through  the  open  wound. 

The  inflammation  may  be  very  superficial,  about  the 
glands  of  Montgomery;  in  the  connective  tissue  of  the 
gland,  removed  from  the  nipple ;  or  it  may  be  beneath 
the  breast — the  submammary  type  of  abscess. 

Symptoms. — There  is  localized  pain  and  tenderness 
over  the  affected  area;  redness  of  the  skin  soon  appears, 
and  there  develops  a  hardened  area  at  the  site  of  the 
inflammation.  Usually  there  is  a  rigor  or  chill,  with 
temperature  which  may  run  quite  high. 


Obstetrical  Nursing 


179 


Treatment. — Withdrawal  of  the  child  from  the  breast,  ■ 
a  binder  tight  enough  to  exert  some  pressure,  the  admin- 
istration of  a  saline  cathartic,  and  the  application  of  an 
ice-bag,  may  prevent  the  formation  of  pus. 

If  an  abscess  results,  free  incision  under  a  general 
anesthetic   is   indicated,   and   daily   dressings   with   hot 


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packs  applied  at  frequent  intervals  until  the  pain  has 
subsided. 

The  application  of  the  Bier  suction  treatment  is  of 
benefit  in  these  cases.  A  glass  bell  jar  large  enough  to 
cover  the  entire  breast  is  applied  and  the  air  exhausted  in 
it  by  a  suction  pump  until  slight  pain  is  felt,  and  allowed 
to  remain  for  thirty  minutes.  This  may  be  repeated 
two  or  three  times  in  the  twenty-four  hours. 

Temperature. — Immediately  after  or  very  shortly 
after  the  completion  of  the  third  stage  of  labor  there  is, 


180  Obstetrical  Nursing 

almost  without  exception,  a  chill,  more  or  less  severe,  and 
a  rise  in  temperature  from  one  to  four  degrees  (100°  to 
103°  F.).  This  rise  is  entirely  physiological,  and  has 
been  variously  explained.  It  is  probably  due  to  the 
absorption  of  fibrin  resultant  from  rapid  tissue  waste 
incident  to  the  great  muscular  effort  of  the  labor.  The 
rise  is  complete  at  the  end  of  the  first  twelve  hours 
postpartum,  and  by  the  end  of  twenty-four  hours  has 
generally  reached  the  normal,  below  100°  F.  The 
occurrence  of  this  chill  and  temperature  rise  indicates 
how  susceptible  a  parturient  woman  is  to  variations  in 
temperature,  and  should  constitute  a  warning  that  to  ap- 
parently trivial  causes  the  temperature  rise  may  be  due. 

A  transient  rise  in  temperature  which  does  not  go 
above  100°  F.  and  lasts  but  a  few  hours  should  be  con- 
sidered compatible  with  the  normal  condition,  and  if  the 
thermometer  range  exceeds  this  her  condition  should 
be  considered  abnormal. 

Upon  the  occurrence  of  fever  our  diagnosis  is  greatly 
assisted  by  a  consideration  of  other  symptoms  presented : 
the  pulse;  the  lochia,  its  quantity,  color,  and  odor;  the 
facial  expression;  the  state  of  involution  and  condition 
of  the  uterus ;  the  state  of  the  bladder ;  the  condition 
of  the  breasts  and  nipples,  and  the  occurrence  of  after- 
pains.  The  following  diseased  states  may  be  mentioned 
as  responsible  for  a  rise  in  temperature  of  a  lying-in 
woman,  named  in  the  order  of  their  frequency  and  im- 
portance :  sepsis,  sapremia,  and  septicemia ;  auto-intoxi- 
cation from  the  bowel ;  malaria ;  mastitis ;  typhoid  fever ; 
epidemic  grip  or  influenza ;  tuberculosis ;  the  exanthe- 
mata; eclampsia;  erysipelas;  pneumonia;  rheumatism; 
gonorrhea. 

There  is  no  such  condition  as  milk  fever;  the  advent 
of  the  milk,  whether  it  appears  gradually  or  with  a  rush, 


Obstetrical  Nursing  181 

as  is  often  seen  in  multiparas  with  large  breasts  con- 
taining a  quantity  of  gland  tissue,  is  not  accompanied 
by  a  rise  in  temperature.  Should  a  rise  above  100°  F. 
be  found,  there  is  present  some  other  condition  which  is 
responsible.  If  there  is  a  localized  tenderness,  pain, 
and  heat  following  an  engorgement  of  the  breast,  or 
' '  cake ' '  so-called,  a  mastitis  is  imminent. 

Auto-intoxication  from  the  bowel  is  a  very  frequent 
cause  of  fever  in  the  puerperium.  Intestinal  auto- 
intoxication is  a  broad  subject  and  one  of  great  interest. 
Following  a  normal  and  specially  prolonged  labor  there 
is  a  semi-paresis  of  the  intestinal  tract.  Nature's  effort 
to  accomplish  a  reposition  of  the  abdominal  organs  in 
their  normal  state  is  not  complete  until  involution  of  the 
uterus  has  been  accomplished.  There  is  lack  of  abdom- 
inal support,  a  distention  of  the  intestines  results  from 
fermentation  therein,  and  a  resorption  is  made  possible. 
The  first  evidence  of  this  condition  is  generally  a  head- 
ache, more  or  less  severe,  with  a  coated  tongue,  bad  taste 
in  the  mouth,  a  tendency  to  the  collection  of  sordes  on 
the  teeth,  constipation,  or  perhaps  the  passage  of  a  few 
scybalas;  intestinal  distention  and  meteorism,  and  a 
temperature  of  101°  to  103°  F.  with  a  proportionately 
rapid  pulse.  There  is  generally  no  chill  as  a  forerunner 
of  the  temperature. 

Malaria  is  unfortunately  used  far  too  often  as  a 
diagnostic  cloak  to  hide  the  true  condition  of  sepsis. 
That  it  may  and  does  occur  is  beyond  doubt.  In  fact, 
malaria,  which  may  perhaps  have  been  latent,  may  be 
lighted  up  by  the  ordeal  of  a  normal  labor,  or,  as  has 
been  noticed,  when  a  pregnant  woman  is  confined  in  a 
house  located  on  a  street  which  has  been  recently  torn 
up  for  repaving,  and  develops  during  the  first  few  days 
afterward  an  attack  of  malaria,  chill,  fever,  and  sweat. 


182 


Obstetrical  Nursing 


The  diagnosis  in  such  a  case  is  plain,  and  is  further 
proved  by  its  response  to  quinine.  Here,  however,  we 
are  apt  to  err  by  administering  quinine  at  once,"instead 
of  making  first  a  microscopic  examination  of  the  blood 
to  establish  a  diagnosis.  In  fact,  one  should  not  make 
a  diagnosis  of  malaria  in  the  puerperal  period  without 


FIG.  72.      TUBERCULOSIS. 


taking  advantage  of  this  easy  diagnostic  aid,  which  is 
absolutely  reliable.  An  attack  of  malaria  may  occur 
at  any  time  during  pregnancy,  or  during  the  lying-in 
period.  The  likelihood  of  the  chill  being  the  onset  of 
an  attack  of  malaria  is  greater  if  it  occurs  late  in  the 
puerperium,  as  sepsis  is  unusual  after  the  first  week. 

Mastitis,  eventuating  in  an  abscess  with  or  without 
suppuration,  is  an  extremely  painful  condition,  and 
because  of  the  local  symptoms  a  mistake  in  diagnosis  is 
hardly  possible  when  the  occurrence  of  fever  is  noted. 


Obstetrical  Nursing  183 

Typhoid  fever  is  a  slow  process,  and  rarely  develops 
postpartum  without  some  evidence  of  its  existence  before 
labor.  Sepsis  is  much  like  typhoid  in  many  of  its  phases, 
and  one  might  be  misled.  Without  the  spots,  tongue, 
Widal  and  diazo  reactions  in  addition  to  the  fever,  one 
would  not  be  justified  in  making  a  diagnosis  of  typhoid 
fever  during  the  puerperium. 

Epidemic  grip  or  influenza  may  attack  a  postpartum 
woman  and  give  a  sharp  rise  in  temperature. 

Pregnancy  occurring  in  a  patient  who  is  afflicted  with 
pulmonary  tuberculosis  may  show  an  entire  ameliora- 
tion of  symptoms  upon  the  beginning  of  the  pregnancy. 
Her  cough,  profuse  expectoration,  sweats,  loss  in  weight 
cease ;  she  eats  and  sleeps  well,  takes  on  flesh,  and 
apparently  "takes  a  new  lease  on  life."  Her  improve- 
ment, however,  is  but  transitory,  and  lasts  only  during 
pregnancy.  Immediately,  like  a  flash,  after  the  com- 
pletion of  labor,  there  is  a  lighting  up  of  her  former 
condition;  night  sweats  begin,  followed  by  a  rise  in  tem- 
perature, cough,  expectoration,  hemorrhage  perhaps,  a 
loss  of  appetite  and  weight,  and  generally  a  speedy  dis- 
solution. 

Of  the  exanthemata,  scarlet  fever  most  frequently 
occurs  as  a  complication  of  the  puerperal  state.  It  must 
be  borne  in  mind  that  a  scarlatinatiform  rash  may  occur 
in  the  course  of  a  septicemia,  and,  vice  versa,  pelvic 
symptoms  may  follow  in  the  train  of  a  scarlet  fever, 
which  resembles  very  much  those  in  sepsis.  It  is  con- 
ceded that  "the  genitalia  is  the  site  of  entrance  of  the 
materies  morbi."  When  it  is  recalled  that  the  vast 
majority  of  deliveries  are  conducted  by  the  general 
practitioner,  it  is  surprising  that  scarlet  fever  does  not 
occur  with  more  frequency.  The  following,  relative  to 
the  peculiarities  of  scarlet  fever  in  the  puerperium,  is 


184  Obstetrical  Nursing 

taken  from  Hirst:  "It  almost  always  appears  in  the 
first  three  days  after  labor;  the  throat  complications  are 
slight;  the  eruption  appears  quickly,  is  rapidly  diffused 
over  the  body,  and  is  apt  to  assume  a  dark-red  color.  It 
exercises  an  unfavorable  influence  over  the  puerperal 
state ;  the  milk  secretion  is  lessened ;  pelvic  inflammation 
occurs  in  a  large  proportion  of  cases;  diarrhea  may 
develop,  and  is  an  unfavorable  sign." 

The  chill,  fever,  pain,  cough,  and  expectoration 
should  render  a  diagnosis  of  pneumonia  easy.  It  is 
much  more  liable  to  occur  during  pregnancy  than  during 
the  puerperium. 

Winckel  was  the  first  to  refer  to  the  fever  accompany- 
ing eclampsia,  in  1865.  Should  the  convulsions  precede 
labor  by  a  few  hours,  or  occur  postpartum,  the  temper- 
ature may  run  quite  high  with  each  convulsion. 

The  close  relationship  between  erysipelas  and  puer- 
peral fever  is  generally  conceded,  the  near  resemblanc 
of  the  streptococcus  erysipelatis  and  the  streptococcus 
pyogenes  probably  explaining  this.  It  also  explains 
why,  in  an  infection  with  the  erysipelas  coccus,  where 
the  site  of  entrance  is  the  genitalia,  evidences  of  rash  are 
seen  so  seldom  upon  the  skin.  The  course  and  symptoms 
of  an  erysipelas,  in  which  the  site  of  entrance  of  the  con- 
tagion is  the  skin,  is  in  no  wise  different  from  an  attack 
under  other  circumstances. 

Puerperal  Mania. — A  pregnant  woman,  especially 
prone  to  nervous  disorders,  depression,  and  melancholia 
before  the  baby  comes,  is  very  liable  to  develop  a  "puer- 
peral mania"  afterward.  This  form  of  insanity  assumes 
many  phases,  as  the  melancholic,  suicidal,  or  homicidal 
types.  These  cases  require  the  very  closest  attention 
and  scrutiny  to  prevent  the  patient  making  way  with 
herself  or  doing  an  injury  to  others,  especially  her  in- 


Obstetrical  Nursing  185 

fant.  She  should  not  be  left  alone  one  moment,  and 
as  soon  as  practicable  removed  to  a  private  institution 
for  the  care  of  such  unfortunates.  Her  nourishment 
must  be  closely  watched,  as  patients  frequently  secrete 
articles  of  diet  in  order  to  make  it  appear  that  they 
have  eaten  them.  Any  articles  with  which  she  can  do 
herself  violence  should  be  removed  from  the  room,  to 
prevent  her  obtaining  possession  of  them. 


CHAPTER  X. 

Advice  to  Expectant  Mothers. 

Necessity  for  Advice. — As  soon  as  a  woman  knows 
she  is  pregnant  she  should  place  herself  under  the  care 
of  the  physician  who  will  attend  her  in  confinement. 
This  is  of  the  utmost  importance,  as  he  will  be  able  to 
forestall  many  conditions  that  may  arise  during  the 
period  of  pregnancy  which  might  prove  a  complication, 
with  perhaps  serious  results. 

The  following  remarks  and  suggestions  are  offered 
because  of  their  important  bearing  upon  the  welfare 
of  the  woman  who  expects  to  go  through  the  nine  months 
of  carrying  her  child  and  the  labor  incident  to  its 
birth,  and  because,  as  a  rule,  so  little  attention  is  paid 
to  unfavorable  symptoms  by  most  women.  We  here 
insist  upon  the  importance  of  a  strict  observance  of  the 
suggestions  offered. 

Corsets. — After  conception  the  form  does  not  begin 
to  change  materially  until  the  fourth  month,  though 
there  may  be  an  earlier  broadening  of  the  back,  before 
the  abdomen  is  noticed  to  enlarge.  From  this  time  it  is 
of  the  greatest  importance  to  remove  all  pressure  which 
will  retard  the  upward  rising  of  the  womb.  The  habit 
of  lacing  the  corsets  tightly,  to  crowd  the  enlarging 
abdomen  downward  in  order  to  conceal  the  real  con- 
dition, is  pernicious  and  should  never  be  done.  It 
seriously  retards  the  development  of  the  child,  may 
cause  a  deformity,  and  interferes  with  the  circulation 
in  all  the  organs  of  the  pelvis.  If  the  breasts  are  large, 
it  is  necessary  for  comfort  that  some  kind  of  support 
be  worn;  there  is  no  objection  to  the  wearing  of  a  corset 
if  it  be  worn  loosely  and  has  only  the  fewest  number  of 


Obstetrical  Nursing  187 

steels.  In  fact,  the  skirt  bands  can  be  worn  with  greater 
comfort  with  this  support;  but  in  the  last  few  weeks 
more  comfort  is  obtained  by  the  removal  of  the  corset. 

Clothing. — The  clothing  should  be  warm  in  winter 
and  cool  in  summer.  Wool  should  predominate  in  the 
underclothing  worn  in  the  winter,  in  order  the  more 
perfectly  to  protect  the  skin  from  chilling;  it  should  be 
changed  often,  because  normally  the  skin  is  very  active 
in  its  excretions.  Loose  outer  clothing  should  be  worn 
as  pregnancy  advances. 

Abdominal  Supporter. — Late  in  pregnancy  the  great- 
est comfort  can  be  obtained  from  wearing  an  abdominal 
supporter.  These  are  made  to  conform  to  the  shape  of 
the  abdomen ;  they  relieve  the  weight  from  the  abdominal 
wall,  and  enable  the  patient  to  walk  with  comfort.  The 
supporter  can  be  obtained  from  any  instrument  store 
and  of  most  druggists.  The  measure  should  be  taken 
around  the  largest  part  of  the  abdomen ;  one  size  smaller 
and  one  size  larger  should  be  obtained  for  trial,  the  ones 
too  small  and  too  large  being  returned.  It  should  be 
worn  from  the  sixth  month  to  the  end  of  pregnancy,  and 
should  be  large  enough  to  be  let  out  as  the  size  increases. 

Exercise. — Regular  daily  exercise  is  of  the  greatest 
importance,  and  too  much  emphasis  can  not  be  placed 
upon  this  direction.  During  the  first  three  or  four 
months  exercise  is  essential,  but  it  should  be  taken 
discreetly ;  horseback  riding,  bicycle  riding,  running  and 
jumping  should  not  be  indulged  in.  The  exercise  should 
not  be  taken  to  the  point  of  great  fatigue,  and,  if  pos- 
sible, after  walking  the  patient  should  recline  for  a  short 
rest  or  nap,  removing  the  street  clothing  before  doing  so 
and  donning  a  loose-fitting  gown.  Women  who  have 
miscarried  should  use  exceptional  care  at  the  time  they 
would  be  due  to  menstruate  if  not  pregnant,  because 


188  Obstetrical  Nursing 

another  miscarriage  is  more  likely  to  occur  at  this  time 
than  at  any  other.  Ordinary  damp  days  should  not  inter- 
fere with  the  regular  exercise,  but  the  feet  should  be 
protected  by  heavy  walking  shoes  and  rubbers,  and  a 
walking  skirt  should  be  worn.  It  can  be  said  with  some 
degree  of  positiveness  that  the  woman  who  is  out-of- 
doors  regularly  during  the  whole  pregnancy  has  a  much 
easier  time  than  one  who  stays  closely  indoors. 

Nursing. — Every  mother  should  nurse  her  infant 
unless  there  is  some  physical  defect  which  prevents, 
and  there  are  but  very  few  of  these.  A  mother  who 
refuses  to  nurse  her  offspring  because  of  a  distaste  for  it, 
or  on  account  of  the  demands  of  society,  is  unfeeling 
and  unnatural.  Such  a  practice  can  not  be  excused  or 
condoned.  To  aid  the  nursing  the  nipples  should  be 
trained,  if  they  are  not  normally  prominent.  Depressed 
or  flat  nipples  are  injured  by  the  wearing  of  tight  clothes 
which  press  upon  them. 

Kidneys. — Attention  is  especially  called  to  the  con- 
dition of  the  kidneys,  and  to  the  importance  of  regular 
examinations  of  the  urine.  There  should  be  sent  to  the 
physician  a  sample  of  the  morning  urine  once  a  month 
from  the  fourth  to  the  seventh  month ;  from  the  seventh 
month  a  sample  should  be  sent  every  two  weeks.  Once 
during  the  sixth,  seventh,  eighth,  and  ninth  months, 
when  the  sample  is  sent,  the  patient  should  measure  the 
total  quantity  passed  in  twenty-four  hours  and  report 
tli is  to  the  physician,  corking  the  bottle  securely  and 
marking  upon  it  the  date  of  its  passage  and  also  her 
name  and  address.  For  a  reminder,  it  is  a  good  plan 
to  note  upon  a  calendar  the  date  the  urine  is  to  be  sent. 

Unusual  Symptoms. — The  following  symptoms  are 
mentioned  as  of  sufficient  importance  to  consult  the 
physician  about  as  soon  as  they  arise,  but  should  any- 


Obstetrical  Nursing  189 

thing  occur  out  of  the  ordinary  it  must  not  be  borne 
without  complaint,  but  should  be  reported  as  soon  as 
possible,  for  frequently  serious  conditions  may  develop 
from  apparently  trivial  things:  excessive  nausea  and 
vomiting;  constipation;  diminished  flow  of  urine  (below 
three  pints  in  twenty-four  hours)  ;  leucorrhea;  swelling 
of  the  feet,  face,  or  hands  occurring  at  any  time  during 
pregnancy;  headache;  dizziness;  dimness  of  vision; 
sleeplessness;  faintness  or  fainting;  black  spots  before 
the  eyes;  loss  of  appetite;  languor  and  lassitude;  loss 
of  blood,  even  if  a  very  small  amount. 

Bowels. — Regular,  daily  evacuations  from  the  bowels 
are  most  essential.  Women  are  normally  constipated, 
and  during  pregnancy  this  condition  is  exaggerated.  If 
this  develops  it  should  be  reported  to  the  physician,  and 
a  remedy  taken  for  its  relief.  This  procedure  is  imper- 
ative and  should  not  be  neglected. 

Bathing. — Regular  bathing  is  essential,  as  the  skin 
must  be  kept  active.  In  warm  weather  a  bath  can  be 
taken  daily,  in  cold  weather  at  least  twice  a  week,  pref- 
erably at  night,  to  avoid  exposure.  Frequent  washing 
of  the  hair  is  best  avoided. 

Diet. — The  diet  during  pregnancy  should  be  the 
most  nutritious  and  varied  possible.  Peculiar  cravings 
are  often  present,  and  if  they  are  very  unusual,  advice 
should  be  sought  before  these  articles  are  indulged  in. 
Too  frequent  eating,  as  well  as  overeating  at  any  one 
meal,  very  often  causes  digestive  disturbances. 

Teeth. — It  is  incident  to  pregnancy  that  the  teeth 
should  give  way,  frequently  causing  toothache  and  great 
discomfort.  Any  dentistry  which  is  imperative  for 
comfort  can  be  done  with  safety,  but  it  is  not  well  to  have 
teeth  extracted  unless  it  is  absolutely  necessary.  Short 
sittings  in  the  chair  for  temporary  fillings  can  be  allowed 


190  Obstetrical  Nursing 

if  not  too  fatiguing  and  too  often  repeated.  In  this  way 
much  trouble  can  be  averted. 

Nurse. — In  the  selection  of  a  nurse  the  patient  should 
be  guided  by  her  physician,  and  never  engage  one  with- 
out his  full  consent  and  approval,  as  there  is  so  much 
that  depends  upon  the  nursing  during  the  lying-in 
period.  There  are  many  excellent  practical  nurses 
among  the  colored  race,  but  one  should  never  be  selected 
without  the  concurrence  of  the  physician. 

Lying-in  Room. — The  room  selected  for  the  lying-in 
should  be  the  brightest  and  most  cheerful  in  the  house, 
stripped  of  all  superfluous  hangings,  and  one  week  be- 
fore the  expected  confinement  it  should  be  thoroughly 
cleaned,  the  carpet  swept,  and  the  walls  and  woodwork 
wiped  down.  No  room  should  be  used  in  which  there 
has  recently  been  a  case  of  contagious  disease,  scarlet 
fever,  measles,  diphtheria,  or  typhoid  fever,  nor  should 
any  bedding  or  mattress  be  used  that  has  previously 
been  used  by  these  cases. 

Preparation  for  Labor. — The  following  articles 
should  be  provided  for  the  room  at  least  two  weeks 
before  the  labor.  All  of  them  should  be  thoroughly 
cleansed,  the  linens  recently  laundered,  and  the  en- 
tire equipment  protected  from  dust  and  not  used 
until  called  for  by  the  nurse  or  doctor.  They  should 
be  placed  where  they  will  be  within  easy  reach  on 
short  notice. 

Two  wash-basins. 

Two  pitchers. 

Two  small  basins. 

One  foot-tub. 

One  bucket  or  pail. 

Six  sheets. 

One  dozen  towels. 


Obstetrical  Nursing  191 

One  soft  blanket  for  wrapping  infant  in  after  birth. 
Wrapped  in  clean  sheet,  pinned  up,  and  laid  away. 
Two  pillow  cases. 

Two  rubber  sheets  for  protecting  bed.  (A  news- 
paper pad  can  be  made  of  several  thicknesses,  used  in 
lieu  of  one  rubber.) 

Douche-pan. 

Soap. 

Six  ounces  alcohol. 

Four  abdominal  binders.  (Made  of  unbleached 
cotton,  li/4  yards  long,  %  yard  wide.) 

Obstetrical  Outfit.— The  following  articles  are 
needed  for  the  labor,  and  can  be  obtained  of  C.  E.  Pfau, 
druggist,  done  up  in  a  hermetically  sealed  box  called 
the  Tuley  Obstetrical  Outfit.  Purchased  in  this  way 
the  cost  is  much  less  than  when  the  articles  are  bought 
singly. 

Obstetrical  pad  for  bed. 

One  dozen  sanitary  pads. 

One  pound  absorbent  cotton. 

Five  yards  sterilized  gauze. 

One  two-quart  fountain  syringe. 

Two  ounces  chloroform. 

One-half  ounce  fluid  extract  of  ergot. 

Tape  for  tying  cord. 

One  drachm  Crede  eye  solution  (2  per  cent  silver 
nitrate  solution). 

Dropper. 

Nail  brush. 

Antiseptic  soap. 

Nail  file. 

Cord  dressing :  01.  ricini,  dr.  2 ;  Balsam  Peru,  min.  4. 

Vaseline. 

One  tube  sterile  vaseline. 


192  Obstetrical  Nursing 

Antiseptic  tablets   (bichloride). 

One  paper  large  safety-pins. 

One  paper  small  safety-pins. 

Six  ounces  saturated  solution  boracic  acid. 

Labor  Pains. — As  soon  as  the  true  labor  pains  begin, 
or  if  the  waters  break  before  the  advent  of  the  pains, 
the  physician  should  be  notified.  The  true  pains  begin 
in  the  back,  running  around  to  the  abdomen.  Pains 
may  occur  about  the  end  of  the  eighth  month;  these 
are  always  located  in  the  abdomen,  and  do  not  as  a 
rule  affect  the  back  at  all.  They  are  called  false  labor 
pains. 

Preparation  of  Patient  for  Labor. — If  there  is  time 
before  the  physician  arrives  the  patient  should  take  a 
full  bath  in  the  tub,  and  as  soon  as  the  nurse  arrives 
a  low  enema  should  be  given.  The  attire  during  labor 
should  be  a  nightgown,  one  or  two  skirts  if  the  weather 
is  cold,  a  double  wrapper  over  all,  stockings  and  slippers, 
and  a  sterile  napkin  to  protect  the  clothes  from  the 
discharges. 

Bed. — If  the  patient  is  wrakened  at  night  by  the 
advent  of  pains  or  the  breaking  of  the  bag  of  waters, 
the  bed  should  be  dismantled  and  prepared  as  follows : 
a  hard  firm  mattress  is  covered  with  a  rubber  sheet  or 
oil -cloth ;  over  this  is  placed  a  sheet,  which  is  pinned  at 
the  four  corners  to  keep  smooth.  Over  this  is  placed 
a  second  rubber,  or  if  this  can  not  be  obtained  a  pad 
made  of  a  number  of  thicknesses  of  newspapers  sewed 
together  and  covered  with  an  old  but  clean  sheet.  This 
is  placed  at  a  point  where  the  hips  will  rest.  Over  this 
is  placed  a  second  sheet  pinned  as  the  first,  a  folded 
sheet  over  this  which  will  stretch  across  the  bed,  and 
a  pad  made  of  a  folded  sheet  for  the  hips  to  rest  on. 
The  pad,  draw-sheet,  the  second  sheet,  and  rubber  or 


Obstetrical  Nursing  193 

newspaper  pad  are  removed  after  the  completion  of 
labor,  leaving  the  bed  covered  with  white  sheet  and 
rubber.  Another  pad,  made  of  a  sheet  or  tufted  cheese- 
cloth and  absorbent  cotton,  is  then  placed  under  the 
hips.  The  bedding  used  in  the  preparation  of  the  bed, 
and  the  rubber,  etc.,  should  be  scrupulously  clean. 


APPENDIX 


APPENDIX 


SOLUTIONS. 

Sterile  Water. — An  ample  supply  of  sterile  water 
should  be  prepared  for  an  obstetrical  case.  In  private 
homes  a  granite  bucket  can  be  procured,  and  after 
thorough  scrubbing  it  is  filled  with  water,  which  is 
allowed  to  boil  for  thirty  minutes.  This  can  then  be 
poured  into  pitchers  which  have  been  previously  steril- 
ized, and  carefully  covered  with  gauze  tied  over  the  top. 
It  does  no  harm  to  strain  the  water  through  gauze  as  it 
is  poured  into  the  pitchers.  Not  less  than  eight  or  ten 
gallons  of  sterile  water  should  be  prepared;  and  only 
water  which  has  been  boiled  should  be  used  for  douches, 
washing  the  hands,  or  for  the  preparation  of  solutions. 

Lysol  Solution. — This  is  usually  used  in  from  1  to  2 
per  cent  solutions,  and  can  be  made  from  a  stock  solu- 
tion, which  is  diluted  as  used,  or  from  the  pure  drug. 
Two  and  one-half  drachms  to  the  pint  will  make  a  2 
per  cent  solution. 

Bichloride  of  Mercury. — This  solution  is  made  from 
stock  tablets ;  one  tablet  dissolved  in  one  pint  of  water 
equals  1-1,000  solution.  This  drug  is  highly  toxic,  and 
should  be  used  with  great  caution. 

Boracic  Acid  Solution. — This  is  most  often  used  in 
a  saturated  solution,  equal  to  4  per  cent.  It  is  made 
by  dissolving  in  hot  water  as  much  powdered  or  crystal- 
line boracic  acid  as  the  water  will  take  up.  This  is 
allowed  to  cool,  and  when  the  excess  has  crystallized  and 
settled  to  the  bottom  the  upper  clear  liquid  is  poured 
into  a  sterile  bottle  for  use. 

Saline  Solution. — Normal  saline  solution  is  made  by 
the  addition  of  one  teaspoon,  level  full,  of  salt  to  a  pint 


198  Appendix 

of  sterile  water;  the  salt  should  be  sterilized  before 
adding  to  the  water,  or  the  solution  boiled  afterward. 
A  double-strength  solution  can  be  made  and  diluted 
one  half  with  hot  water  before  using. 

Carbolic  Acid  Solution. — Commercial  carbolic  acid 
is  in  the  form  of  crystals.  To  a  pound  of  carbolic  acid 
is  added  five  and  one-half  drachms  of  alcohol.  This 
solution  is  added  to  the  desired  amount  of  boiling  water 
and  filtered  through  cotton  or  strained  through  several 
thicknesses  of  gauze. 

STERILIZATION. 

Aseptic  obstetrics  is  a  goal  toward  which  every 
physician  and  nurse  is  striving.  These  preparations 
include  the  preparation  of  the  room,  the  bed,  the  patient 
and  her  clothing,  the  nurse,  the  physician,  the  instru- 
ments, solutions,  and  dressings.  Sterilization  of  hands 
and  instruments  are  here  considered. 

No  method  of  hand  sterilization  is  perfect,  and  the 
only  safe  method  of  delivery  is  when  wearing  sterile 
rubber  gloves.  If  gloves  are  not  to  be  had  the  hands 
should  be  scrubbed  with  a  sterile  nail-brush,  soap  and 
water  for  three  minutes;  clean  the  finger-nails  with 
a  dull  nail  file  or  stick,  and  scrub  again  in  sterile  water 
for  five  minutes.  Wash  the  hands  in  95  per  cent 
alcohol  and  rinse  in  sterile  water.  As  long  as  the  hands 
do  not  touch  an  unsterilized  object  they  are  then  as 
sterile  as  it  is  possible  to  make  them. 

Sterile  rubber  gloves  offer  the  ideal  method  of  pro- 
tecting the  patient  against  infection  from  the  hands. 
They  should  be  closely  inspected  for  holes  by  distend- 
ing with  air  and  holding  under  water.  Escaping  air 
will  be  shown  by  the  bubbles. 

Gloves  must  be  wrapped  in  gauze  or  a  small  towel 


Appendix  199 

and  boiled  for  fifteen  minutes  for  sterilization,  and 
may  be  put  on  wet,  partly  filled  with  water,  after  the 
hands  have  been  prepared  as  described  above.  The 
gloves  may  be  sterilized  some  time  before,  dried  with 
sterile  towel  and  powdered  with  a  sterilized  talcum 
powder,  and  put  on  sterilized  hands,  which  have  also 
been  dried  and  powdered. 

After  being  used  the  gloves  are  thoroughly  washed 
with  soap  and  water,  with  equal  care  upon  both  sides, 
dried  and  powdered  with  talc  or  boracic  acid,  wrapped 
in  sterile  gauze,  and  put  in  box  for  use  next  time. 

Instruments  should  be  immersed  in  water  containing 
about  1  per  cent  of  borax  or  soda  and  thoroughly  boiled 
for  at  least  ten  minutes,  removed  from  the  solution  at 
this  time,  wiped  with  sterile  towel,  and  covered  with  a 
sterile  towel  until  ready  for  use.  After  using  the  instru- 
ments they  should  be  carefully  scrubbed  with  soap  and 
water,  boiled  for  five  minutes,  and  wiped  with  a  sterile 
towel. 

An  expensive  nail-brush  should  not  be  used.  They 
do  not  stand  successive  boiling,  and  the  bristles  usually 
lose  their  stiffness  and  efficiency.  A  five-cent  wooden- 
back  nail-brush,  which  can  be  used  for  but  one  case, 
is  decidedly  the  best.  In  an  institution  a  jar  or  tray 
deep  enough  for  the  brush  to  be  immersed  in  a  lysol 
solution  should  be  provided,  and  the  brush  not  care- 
lessly laid  down  on  the  stand.  Brushes  should  be  boiled 
for  ten  minutes  before  using. 

Dressings  should  be  submitted  to  dry  sterilization 
before  using.  The  nurse  should  visit  the  patient  in 
her  home  some  weeks  before  the  confinement,  to  assist 
in  the  preparation  of  the  lochial  and  bed  pads,  and 
give  instructions  in  regard  to  pinning  up  the  packages 
of  towels,  sheets,  gowns,  and  dressings  for  sterilization. 


200  Appendix 

These  packages  are  then  placed  in  the  oven  and  baked 
for  thirty  minutes.  They  are  removed  and  laid 
away  with  the  remainder  of  the  things  prepared  for 
the  labor,  and  covered  so  as  to  be  free  from  dust. 

Basins  and  pitchers  should  be  scrubbed  thoroughly, 
rinsed,  and  boiled  in  a  large  boiler  deep  enough  to 
allow  them  to  be  completely  immersed.  They  are  then 
dried  with  a  sterile  towel  and  protected  from  dust  until 
used. 

Washing  Flannels. — To  wash  flannels  without  hav- 
ing them  shrink,  shave  laundry  soap  and  add  enough 
water  to  boil  down  to  soft  soap ;  use  hot  water  and  soft 
soap  to  make  a  heavy  lather ;  add  a  teaspoonful  of  borax 
and  a  tablespoonful  of  ammonia  to  a  foot-tub  half  full 
of  water.  Squeeze  the  flannels  in  these  suds,  but  only 
to  get  obstinate  spots  out;  rinse  in  hot  water,  with 
borax  and  ammonia ;  dry  quickly,  and  press  while 
damp.  Flannels  thus  treated  will  not  shrink,  and  need 
no  stretchers. 


Appendix 


201 


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GLOSSARY 


GLOSSARY 


With  but  few  exceptions,  the  words  and  definitions  included  in  this  Glossary 
are  taken  from  the  American  Illustrated  Medical  Dictionary  by  Dorland  (copy- 
right, 1909,  by  W.  B.  Saunders  Company),  with  the  permission  of  the  publishers. 


Abdomen  (ab-do'men).  That  portion  of  the  body  which  lies  between 
the  thorax  and  the  pelvis. 

Ablactation  (ab-lak-ta'shun).  The  weaning  of  a  child,  or  the  cessation 
of  the  secretion  of  milk. 

Abortion  (ab -or 'shun).  The  expulsion  of  the  embryo  before  the  end  of 
the  third  month. 

Accoucheur    (ah-koosh-er' ).      One   skilled   in   midwifery;    an   obstetrician. 

Accoucheuse   (ah-koosh-ez' ).     A  midwife. 

Acephalia,  Acephalism,  Acephaly  (ah-sef-a'le-ah,  ah-sef'al-ism,  ah-sef'al-e). 
Absence  of  the  head. 

Acephalobrachia  (ah-sef  'al-o-bra'ke-ah).  Congenital  absence  of  the  head 
and  arms. 

Acephalocardia    (ah-sef 'al-o-kar'de-ah).     Absence  of  the  head  and  heart. 

Acephalochiria    (ah-sef 'al-o-ki're-ah).     Absence  of  the  head  and  hands. 

Afetal   (ah-fe'tal).     Without  a  fetus. 

After-birth.  The  structure,  consisting  of  the  placenta  and  membranes, 
cast  from  the  uterus  after  the  birth  of  the  child. 

After-pains.  The  pains  felt  after  the  birth  of  the  child,  due  to  the  con- 
traction of  the  uterus. 

Agalactia   (ah-gal-ak'she-ah).      Absence  or  failure  of  the  secretion  of  milk. 

Albuminuria  (al-bu-min-u're-ah).  The  presence  of  albumen  in  the  urine. 
It  indicates  either  a  simple  mixture  of  albuminous  matters,  as 
blood,  with  the  urine,  or  a  morbid  state  of  the  kidneys,  permitting 
albumen  to  pass  from  the  blood. 

Allantoic   (al-an-to'ik).      Pertaining  to  the  allantois. 

Allantois  (ai-an'to-is).  A  sae  which  in  early  fetal  life  springs  out  from 
the  hind-gut  of  the  embryo.  It  afterward  arches  around  so  as  to 
envelop  the  embryo  completely,  and  fuses  with  the  subzonal  mem- 
brane to  form  the  chorion  and  placenta.  It  carries  the  blood-vessels 
from   the   embryo   which    establish   the   placental    circulation. 

Amenia   (am-e'ne-ah).     Absence  of  the  menses. 

Amenorrhea,  Amenorrhcea  (am-en-or-re'ah).  Absence  or  abnormal 
stoppage  of  the  menses.  Primitive  A.,  a  condition  in  which  the 
menstruation  has  not  appeared  at  the  proper  time.  Secondary  A., 
arrest  of  the  menses  after  they  have  once  existed. 

Amnion  (am'ne-on).  The  innermost  fetal  membrane,  forming  the  bag  of 
waters,  the  sac  that  encloses  the  fetus  and  forms  a  sheath  for  the 
umbilical  cord.  It  consists  of  two  layers:  the  outer  (false  A.);  the 
inner  (true  A.),  and  develops  from  the  ectoderm  and  mesoderm.  The 
false  amnioa,  or  subzonal  membrane,  lies  outside  the  sac  of  the  true 
amnion,  from  which  it  becomes  separated.  It  unites  with  the 
allantois  and  forms  the   chorion. 

Amniorrhea  (am-ne-or-e'ah).  The  escape  of  the  amnionic  waters,  or 
liquor   amnii. 

Analgesia   (an-al-je'ze-ah).     Absence  of  sensibility  to  pain. 

Analgesic  (an-al-je'zik).  (1)  Relieving  pain.  (2)  Not  sensitive  to  pain. 
(3)  A  remedy  for  pain. 

Anamniotic   (an-am-ne-ot'ik).     Having  no  amnion. 

Anencephalia,  anencephaly  (an"en-sef-a'le-ah,  an-en-sef 'al-e).  Absence 
of  the  brain. 


206  Glossary 

Anesthesia,  Anaesthesia  (an-es-the'zhe-ah).  Loss  of  feeling  or  sensation, 
especially  loss  of  tactile  sensibility,  though  the  term  is  used  for  loss 
of  any  of  the  other  senses. 

Anesthetic  (an-es-thet'ik).  (1)  Without  the  sense  of  touch  op-  of  pain 
(2)  A  drug  that  produces  anesthesia.  General  A.,  one  whose  admin- 
istration affects  the  whole  organism.  Obstetrical  A.,  anesthesia 
during  labor,  sufficient  to  relieve  the  acute  suffering  but  not  to 
produce   entire   insensibility. 

Anesthetist    (an-es' thefist).      An  expert  in  administering  anesthetics. 

Ankylocolpos,  Ankylokolpos  (ang-kil-o-kol'pos).  Atresia  or  imperf ora- 
tion of  the  vagina. 

Ankyloglossia,  Ankyloglossum  (ang-kil-o-glos'se-ah,  ang-kil-o-glos'um). 
Tongue-tie. 

Anococcygeal   (a-no-kok-sij'e-al).     Pertaining  to  the  anus  and  coccyx. 

Anodyne  (an'o-dTn).  (1)  Relieving  pain.  (2)  A  medicine  that  relieves 
pain.  The  anodynes  include  opium,  morphine,  codeine,  hyoscine, 
atropine,  coniine,  ether,  lupulin,  potassium  bromide.  Hoffman's  A., 
the  compound  spirit  of  ether  (spiritus  se'theris  compos 'itus),  ano- 
dyne and  antispasmodic.     Dose,  30-120  min.    (2-8  c.c). 

Anorectal   (a-no-rek'tal).     Pertaining  to  the  anus  and  rectum. 

Anorexia    (an-o-rek'se-ah).     Lack  or  loss  of  the  appetite  for  food. 

Anovesical    (a-no-ves'ik-al).      Pertaining    to    the    anus    and    bladder 

Anteflexion  (an"te-flek'shun).  An  abnormal  forward  curvature;  a  form 
of  displacement  in  which  the  upper  part  of  the  organ  is  bent  forward. 

Antenatal    (an-te-na' tal).      Occurring  before  birth,  or  formed. 

Antepartum    (an'te-par' turn).     Latin  for   "before  delivery." 

Anteversion  (an-te-ver'shun).  The  forward  tipping  or  tilting  of  an 
organ;  displacement  in  which  the  organ  is  tipped  forward,  but  is  not 
bent  at  an  angle,   as  in  anteflexion. 

Antihemorrhagic  (ant"hem-or-raj 'ik).  Preventing  or  arresting  hemor- 
rhage. 

Antisepsis  (an-te-sep'sis).  Exclusion,  by  the  use  of  drugs,  of  the  germs 
that  cause  putrefaction. 

Antiseptic  (an-te-sep'tik).  (1)  Preventing  decay  or  putrefaction.  (2) 
A  substance  destructive  to  poisonous  germs.  Some  of  the  chief  anti- 
septics are  alcohol,  boric  acid,  carbolic  acid,  creosote,  corrosive  sub- 
limate, common  salt,  charcoal,  chlorine,  tannic  acid,  sugar,  and 
vinegar. 

Anus  (a'nus).  The  distal  end  and  outlet  of  the  rectum.  Imperforate  A., 
closure    of    the    natural    opening    of    the    anus. 

Aperient    (ap-e're-ent).      (1)    Mildly  cathartic.      (2)    A  gentle  purgative. 

Areola  (ar-e'o-lah).  The  darkish  ring  around  the  nipple.  A.  papila'ris, 
the  darkened  ring  around  a  woman's  nipple.  Second  A.,  a  deposit 
of  pigment  outside  the  primary  areola  during  pregnancy. 

Asphyxia  (as-fix'e-ah).  Suffocation;  also  suspended  animation  from 
suffocation  or  a  deficiency  of  oxygen  in  the  blood.  It  is  attended 
by  a  feeling  of  suffocation,  cyanosis,  and  coma.  A.  Neonato '  ruin, 
imperfect  breathing,   as  in  newborn   infants. 

Attitude.  The  relation  of  the  head  and  extremities  of  the  child  to  its 
body  as  it  lies  in  the  uterus;  head  flexed  on  the  chest,  arms  across 
the  chest,  thighs  flexed  on  the  abdomen,  legs  on  the  thighs  and  back 
of  foot  on  the  shin. 


Bacilluria    (bas-il-lu're-ah).     The  presence  of  bacilli  in  the  urine. 
Bacillus    (bas-il'lus).      (1)    A   rod-shaped   body.       (2)    A   genus    of   schizo 

mycetOUS  microorganisms,   consisting  of  non-motile  rod-like  forms. 
Bacteremia   (bak-ter-e'me-ah).     The  presence  of  bacteria  in  the  blood. 


Glossary  207 


Bacteria  (bak-te're-ah).  The  schizomycetes,  or  vegetable  microorgan- 
isms, especially  the  short-rod  forms.  Amotile  B.,  bacteria  which  are 
incapable   of  motion,    as   the   bacilli    of   anthrax. 

Bactericidal   (bak'ter-is-i-dal).     Destructive  to  bacteria. 

Bactericide  (bak-ter'Is-id).  (1)  Destructive  to  bacteria.  (2)  Any  agent 
that  destroys  bacteria. 

Bacteriemia  (bak'ter-e-e'me-ah).  The  presence  of  schizomycetes  in  the 
blood. 

Bacteriology  (bak"te-re-ol'oj-e).  The  sum  of  what  is  known  regarding 
bacteria. 

Bacterium  (bak-te're-um).  (1)  A  genus  of  schizomycetes  of  short  and 
rod-like  form.      (2)    Any  non-animal  microorganism;    a  microphyte. 

Bacteriuria   (bak"te-re-u're-ah).     The  existence  of  bacteria  in  the  urine. 

Bacteroid  (bak'te-roid).  Resembling  a  bacterium;  also  a  structure  re- 
sembling a  bacterium. 

Bag.  A  sac  or  pouch.  Barnes'  B.,  a  rubber  bag  for  dilating  the  cervix 
uteri.  Ice  B.,  a  bag  filled  with  ice,  for  applying  cold  to  the  body. 
B.  of  Waters,  the  membranes  which  enclose  the  liquor  amnii  and  the 
fetus. 

Balanitis  (bal-an-i'tis).  Inflammation  of  the  foreskin  and  the  glans 
penis.     It  is  usually  associated  with  phimosis. 

Ballottement  (bal-lot-maw' ).  The  diagnosis  of  pregnancy  by  pushing  up 
the  uterus  by  a  finger  inserted  into  the  vagina,  so  as  to  cause  the 
embryo  to  rise  and  fall  again  like  a  heavy  body  of  water.  Abdomi- 
nal B.,  Indirect  B.,  that  which  is  effected  by  the  finger  applied  to  the 
abdominal  wall.  Direct  B.,  Vaginal  B.,  that  done  by  the  finger  in 
the  vagina.  B.  of  the  Eye,  Ocular  B.,  the  falling  of  opaque  masses 
in  a  fluid  vitreous  after  movements  of  the  eyeball. 

Basiotribe  (ba'se-o-trib).  An  instrument  for  crushing  the  fetal  head,  in 
order  to  facilitate  delivery. 

Bell's  Palsy.     Paralysis  of  the  facial  nerve. 

Binder.     An  abdominal  girdle  or  bandage,   chiefly  for  women  in  childbed. 

Biology  (bi-ol'o-je).  The  science  of  living  organisms,  and  of  their 
structure,   life,  growth,  and  actions. 

Birth.  (1)  The  act  or  process  of  being  born.  (2)  That  which  is  born. 
Cross-B.,  preternatural  labor  with  fetus  lying  transversely.  Head-B., 
a  birth  in  which  the  head  presents.  B.-Mark,  a  congenital  nevus. 
B.-Palsy,  any  paralytic  affection  due  to  an  injury  occurring  at  birth. 

Bladder.  The  membranous  sac,  situated  in  the  anterior  part  of  the  pelvic 
cavity,  which  serves  as  a  reservoir  for  the  urine. 

Blastocele,  Blastocoele  (blas'to-sel).  The  cavity  of  a  blastula  or  vesicu- 
lar morula. 

Blastoderm  (blas'to-derm).  The  delicate  membrane  which  lines  the  zona 
pellucida  of  the  impregnated  ovum.  The  blastoderm  is  formed  by 
the  cells  (blastomeres)  which  result  from  the  splitting  up  of  the 
ovum  after  impregnation,  and  have  been  pushed  from  the  center  of 
the  accumulation  of  the  blastochyle.  The  blastoderm  forms  a  hollow 
sphere  (blastodermic  vesicle).  Trilaminar  B.,  the  stage  of  develop- 
ment in  which  the  embryo  is  represented  by  the  three  primary  layers 
— the  ectoderm,  the  mesoderm,  and  the  entoderm. 

Elastogenesis,  Blastogeny  (blas-to-jen'es-is,  blas-toj  'en-e).  The  germ- 
history  of  an  organism  or  species. 

Blastomere    (blas'to-mer).      Any  cell   or  cell-mass   of  the  blastoderm;    one 

of  the  masses  which  constitute  the  morula. 
Blastosphere     (blas'to-sfer).      The    ovum    after    it    has    passed    into    the 

morula   stage. 
Blastula    (blas'tu-lah).      Same  as  Blastosphere. 

Blastulation   (blas-tu-la'shun).     The  formation  of  the  blastula. 
Bougie     (boo-zhe').       A    slender    instrument    for    introduction    into    the 
urethra,   or  a  large   one,   for  the  rectum  or  some  other  orifice ;    used 
also  to  induce  labor  by  introduction  into  the  uterus. 


208  Glossary 


Breast.  The  anterior  aspect  of  the  chest  or  thorax.  (2)  The  mamma  or 
mammary  gland.  B.  Pump,  an  apparatus  for  drawing  milk  from 
mammary  gland. 

Breech   (brech).      The  nates  or  buttocks. 

Bregma  (breg'mah).  The  point  on  the  surface  of  the  skull  at  the  junc- 
tion of  the  coronal  and  sagittal  sutures. 

Bregmatie   (breg-mat'ik).     Pertaining  to  the  bregma. 

Brim.     The  edge  of  the  superior  strait  of  the  pelvis. 

Bruit  (brue).  A  sound  or  murmur  heard  in  auscultation;  especially  an 
abnormal  one.  B.  Placentaire,  a  blowing  sound  heard  in  the  preg- 
nant uterus,  and  caused  by  the  fetal  circulation. 


Calorie,  Calory  (kal-lor-e' ).  A  heat-unit;  it  being  the  amount  of  heat 
needed  to  raise  one  kilogram  of  water  from  0°  to  1°   C. 

Cannula  (kan'u-lah).  A  tube  for  insertion  into  the  body,  its  caliber 
being  usually  occupied  by  a  trocar  during  the  act  of  insertion. 

Caput  (ka'put).  Any  head  or  headlike  structure.  C.  Succeda'neum,  a 
swelling  formed  on  the  presenting  part  of  the  fetus  during  labor, 
composed  of  serum  in  the  cellular  tissue. 

Caruncle  (kar'ung-kl).  Any  small  fleshy  eminence,  whether  normal  or 
abnormal. 

Caruncula  (kar-ung'ku-lah).  Carunculae  Myrtiformes,  small  elevations 
surrounding  the  vaginal  orifice,  relics  of  the  ruptured  hymen,  due  to 
dilatation   at   childbirth. 

Casein  (ka'se-in).  The  principal  proteid  of  milk  and  the  basis  of  cheesc_. 
It  is  a  white  substance,  soluble  in  dilute  acids  and  alkalies,  and 
resembles  alkali-albumen,  but  contains  more  nitrogen. 

Caseinogen  (ka-se-in'o-jen).  A  proteid  of  milk,  producing  casein  when 
acted  upon  by  digestive  ferments. 

Caseous    (ka'se-us).     Resembling  cheese  or  curd. 

Cast.  A  model  of  a  hollow  organ,  as  of  a  renal  tubule  or  a  bronchiole, 
formed  of  effused  plastic  matter. 

Cataria  (kat-a're-ah).  The  leaves  and  top  of  Nep'eta  Cata'ria,  or  cat- 
nip, a  labiate  plant:  a  carminative  and  mild  nerve-stimulant.  Dose 
of  the  infusion,  2   dr.    (7.77  gm.). 

Catgut.  Sheep's  intestine  prepared  as  a  cord,  asepticized  and  used  as  a 
ligature  and  in  drainage.  Chromic  C,  Chromicised  C,  catgut  steri- 
lized and  impregnated  with  formalin  by  boiling  in  an  alcohol-forma- 
lin solution.  Iodine  C,  catgut  that  has  been  immersed  in  a  solution  of 
iodine  and  iodide  of  potassium.  Silverized  C,  catgut  impregnated 
with  silver  to  give  it  increased  strength  and  resisting  qualities. 

Catharsis   (kath-ar'sis).     A  cleansing  or  purgation. 

Cathartic  (kath-ar'tik).  (1)  Purgative  or  causing  purgation.  (2)  A 
medicine  that  quickens  and  increases  the  evacuation  from  the  bowels 
and  produces   purgation. 

Catheter  (kath'e-ter).  A  tubular  surgical  instrument  for  discharging 
fluids  from  a  cavity  of  the  body  or  for  distending  a  passage. 

Catnep,  Catnip   (kat'nep,  kat'nip).     See  Cataria. 

Caul.  A  piece  of  amnion  which  sometimes  envelops  a  child's  head  at 
birth. 

Celiotomy   (se-le-ot'o-my).     Surgical  incision  through  the  abdominal  wall. 

Cephalematoma  (sef'al-em-at-o'mah).  A  tumor  or  swelling  filled  with 
blood  beneath  the  pericranium. 

Cephalothoracopagus  (sef"al-o-tho-rak-of '^ag-us).  A  double  monster  con- 
sisting of  two  fetuses  joined  by  the  head  and  thorax. 

Cephalotome    (sef'al-o-tom).      An  instrument  for  cutting  the  fetal   head. 

Cephalotomy  (sef-al-ot'o-me).  (1)  The  cutting  up  of  the  fetal  head  to 
facilitate  delivery.      (2)   Dissection  of  the  fetal  head. 

Cephalotribe    (sef 'al-o-trib).     An  instrument  for  use  in  cephalotripsy. 


Glossary  209 


Cephalotripsy  (sef 'al-o-trip-se).  The  crushing  of  the  fetal  head  in  order 
to  facilitate   delivery. 

Cereal.  (1)  Pertaining  to  edible  grain.  (2)  Any  graminaceous  plant 
bearing  an  edible  seed;  also  the  seed  or  grain  of  such  a  plant. 

Cereo    (se're-o).     A  proprietary  agent  for  predigesting  starchy  foods. 

Cervico-occipital  (ser"vik-o-ok-sip'et-al).  Pertaining  to  the  neck  and 
occipiit. 

Cervicovesical  (ser"vik-o-ves'ik-al) .  Pertaining  to  the  cervix  uteri  and 
bladder. 

Cervix  (ser'vix).  The  neck  or  any  neck-like  part.  C.  Uteri,  the  lower 
and  narrow  end  of  the  uterus,  between  the  os  and  the  body  of  the 
organ.     C.  Vesicae,  the  neck  of  the  urinary  bladder. 

Change  of  Life.  The  menopause,  or  normal  and  final  cessation  of  the 
menses,   often  attended  with  various   constitutional   disturbances. 

Childbed.     The  puerperal  state,  condition,  or  season;   lying-in. 

Childhood.  The  period  of  life  before  puberty,  and  especially  that  which 
follows  infancy. 

Chloasma  (klo-az'mah).  A  cutaneous  discoloration,  occurring  in  yel- 
lowish-brown patches  and  spots.  The  term  is  applied  vaguely  to 
various  pigmentary  skin-discolorations.  C.  Uterinum,  a  skin-dis- 
coloration  which  occurs   during  gestation. 

Chlorosis  (klo-ro'sis).  Green  sickness;  a  peculiar  anemia  mostly  affect- 
ing girls  about  the  age  of  puberty;  so  called  from  the  greenish  pallor 
of  the  skin.  It  is  marked  by  perverted  appetite,  digestive  impair- 
ment, debility,  dysmenorrhea,  amenorrhea,  and  nervous  disturbance. 
Egyptian   C,    ankylostomiasis. 

Chorion  (ko're-on).  The  more  external  of  the  two  fetal  membranes, 
formed  by  the  outer  portion  of  the  allantois  pushing  in  between  the 
true  and  false  amnion  and  uniting  with  the  latter  to  envelop  the 
ovum.  C.  Frondo'sum,  the  part  of  the  chorion  that  is  covered  with 
villi.  C.  Laeve,  the  smooth  and  membranous  part  of  the  chorion. 
Primitive  C,  that  stage  of  the  zona  pellucida  during  which  it  devel- 
ops many  small  villi.      Shaggy  C,   same  as  C.  Frondosum. 

Chorionic   (ko-re-on'ik).     Pertaining  to  the  chorion. 

Circulation.  Movement  in  a  regular  or  circuitous  course,  as  the  circula- 
tion of  the  blood.  Allantoic  C,  circulation  in  the  fetus  through  the 
umbilical  vessels.  Vitelline  C,  the  circulation  through  the  blood- 
vessels ramifying  upon  the  yolk. 

Circumcision.     The  removal  of  all  or  a  part  of  the  prepuce  or  foreskin. 

Cleft  Palate.      Congenital  fissure  of  the  nalate  and  roof  of  the  mouth. 

Clitoris  (klit'o-ris).  An  organ  of  the  female  homologous  with  the  penis 
in  the  male.  It  is  a  small,  elongated,  erectile  body,  situated  at  the 
anterior  angle  of  the  vulva. 

Clot.     A  soft,  semisolidified  mass  or  coagulum,  as  of  blood  or  lymph. 

Clyster   (klis'ter).     An  injection  into  the  rectum;   an  enema. 

Clysterium    (klis-te're-um).     A  clyster. 

Clysterize   (klis'ter-iz).     To  apply  a  clyster  to;  to  treat  with  enema ta. 

Coccygeal   (kok-sij'e-al).     Of  or  pertaining  to  the  coccyx. 

Coccyx  (kok'six).  The  small  bone  situated  caudal  to  the  sacrum;  in 
man,  the  caudal  end  of  the  spinal  column. 

Coitus    (ko' it-us ).      Sexual  intercourse;    copulation. 

Colic.      (1)   Pertaining  to  the  colon.      (2)   Acute  abdominal  pain. 

Colon.  That  part  of  the  large  intestine  which  extends  from  the  cecum 
to  the  rectum.  Ascending  C,  the  portion  of  the  colon  on  the  right 
side,  going  cephalad  from  the  cecum.  Descending  C,  a  part  of  the 
colon  on  the  left  side  between  the  transverse  colon  and  the  sigmoid 
flexure.  Giant  C,  abnormally  large  size  of  the  colon.  Transverse 
C,  that  part  which  runs  transversely  across  the  upper  part  of  the 
abdomen  from  right  to  left. 

Colostration  (ko-los-tra'shun).  Illness  of  a  newborn  infant  caused  by 
the  colostrum. 


210  Glossary 


Colostrorrhea    (ko-los-tro-re'ah).      Spontaneous   discharge  of   colostrum. 

Colostrum  (ko-los'trum).  The  first  fluid  secreted  by  the  mammary  gland 
after  delivery.  It  contains  less  casein  and  more  albumen  than  ordi- 
nary milk,  as  well  as  numerous  fatty  globules  (colostrum  corpus- 
cles) . 

Colpeurynter  (kol'pu-rin-ter).  A  dilatable  bag,  used  to  distend  the 
vagina. 

Colpeurysis    (kol-pu'ris-is).      Operative  dilatation  of  the  vagina. 

Colpitis   (kol-pi'tis).     Inflammation  of  the  vagina. 

Colpocele    (kol'po-sel).      Hernia  into  the  vagina. 

Colpocystitis  (kol"po-sis-ti'tis).  Inflammation  of  the  vagina  and  of  the 
bladder. 

Colpocystotomy  (kol"po-sis-tot'o-me).  Incision  of  the  bladder  through 
the   vaginal   wall. 

Colporrhaphy  (kol-por'rah-fe).  The  operation  of  denuding  and  suturing 
the  vaginal  wall   for  the  purpose  of  narrowing  the  vagina. 

Colpospasmus    (kol-po-spaz'mus).     Vaginal  spasm. 

Colpotomy  (kol-pot'o-me) .  Any  surgical  cutting  operation  upon  the 
vagina. 

Conception.  (1)  The  fecundation  of  the  ovum.  (2)  The  image  of  a 
thing  in  the  mind. 

Confinement.     Childbed,   or  the  puerperal  condition. 

Constipated.     Affected  with  constipation;   costive. 

Constipation.  Infrequent  or  difficult  evacuation  of  the  feces;  retention  of 
the  feces.  Spastic  C,  constipation  marked  by  spasmodic  constriction 
of  a   portion  of  the   intestine,   seen   in  neurasthenia. 

Copulation    (kop-u-la'shun).      Sexual  congress;   coitus. 

Cornu    (kor'nu).      Any  horn-like  excrescence  or  projection. 

Courses.      Menses;   the  monthly   illness  of  a  woman. 

Crrnioclasis    (kra-ne-ok'lah-sis).      The   crushing  of   the   fetal   head. 

Crcnioclast  (kra'ne-o-klast).  An  instrument  for  use  in  performing  era- 
nioclasis. 

Crrnio^ome  (kra'ne-o-tdm).  An  instrument  for  use  in  performing  crani- 
otomy. 

Craniotomy  (kra-ne-ot'o-me).  The  cutting  in  pieces  of  the  fetal  head  to 
facilitate   delivery. 

Creche.     See  Day  Nursery. 

Crest.  A  projecting  ridge,  especially  one  which  surmounts  a  bone  or  its 
border.  C.  of  the  Ilium,  the  thickened  and  expanded  upper  border 
of  the  ilium. 

Crista.     A  crest  or  ridge. 

Cry.      A  sudden  loud  vocal   sound. 

Cryptorchid,  Cryptorchis  (krip-tor'kid,  krip-tor'kis).  A  person  whose 
testicles  have  not  descended   into  the  scrotum. 

Cul-de-sac.  A  blind  pouch  or  cecum;  a  cavity  closed  at  one  end.  Doug- 
las' C,  a  pouch  between  the  anterior  wall  of  the  rectum  and  the 
uterus. 

Curettage  (ku-ret-aje' ).  The  use  of  the  curette,  or  treatment  by  the 
curette. 

Curette  (ku-ref).  A  kind  of  scraper  or  spoon  for  removing  growths  or 
other  matter  from   the  walls   of  cavities. 

Curettement    (ku-ret'ment).      Same  as   Curettage. 

Cyst.  Any  sac,  normal  or  other;  especially  one  which  contains  a  liquid 
or  semisolid. 

Cystalgia    (sis-tal '  je-ah).      Pain   in  the  bladder. 

Cystitis    (sis-ti'tis).      Inflammation    of  the  bladder. 

Cystopyelitis    (sis"to-pi-el-i'tis).      Cystitis   complicated    with    pyelitis. 

Cystoscope  (sis'to-skop) .  An  endoscope  for  examining  the  interior  of 
the  bladder. 

Cystoscopy  (sis-tos'ko-pe).  Examination  of  the  bladder  with  the  cysto- 
scope. 


Glossary  211 

Cystotomy    (sis-tot 'o-me).      The   operation   of  making  an   incision   into   the 

bladder. 
Cytogenesis    (si-to-jen'es-is).      The  development  of  the  cell. 

D 

Day  Nursery.      Creche,   or  shelter  for  children. 

Decidua  (de-sid'u-ah) .  The  membranous  structure  produced  in  the  uterus 
during  gestation  and  thrown  off  after  parturition.  D.  Gravidita'  tis, 
the  menstrual  decidua  during  the  stage  of  pregnancy.  D.  Mem- 
bra'na,  D.  Reflex 'a,  the  part  of  decidua  which  is  reflected  upon  and 
surrounds  the  ovum.  D.  Menstrua 'lis,  the  hyperemic  and  swollen 
mucous  membrane  of  the  uterus  during  the  menstrual  period.  Ovu- 
lar D.  See  D.  Reflexa.  Placental  D.  See  D.  Serotina.  D.  Serot'- 
ina,  the  late  decidua;  the  part  of  the  decidua  vera  which  becomes 
the  maternal  portion  of  the  placenta.  Uterine  D.  See  D.  Vera. 
D.  Ve'ra,  the  true  decidua;  the  portion  of  the  decidua  which  lines 
the  uterus. 
Decidual  (de-sid'u-al) .  Pertaining  to  the  decidua. 
Decidualitis   (de-sid"u-al-i'tis) .     A  bacterial  disease  leading  to  alterations 

in  the  decidua. 
Deciduous    (de-sid'u-us).     Not  permanent;   temporary. 
Decipara    (des-ip-ar'ah).      A  woman  who  has  borne  ten  children. 
Dejecta.      Excrementitious  substances. 
Dejection.      (1)    Discharge   of   excrementitious   material;    also   material    so 

discharged.      (2)    Prostration;    mental   depression. 
Deliver.      (1)    To   aid  in  the  process   of   childbirth.      (2)    To   remove — as 

the   fetus,    or  placenta,    or  the   lens    of   the   eye. 
Delivery.      (1)    Expulsion   or   extraction    of   the    child   at   birth.       (2)    Re- 
moval of  a  part,  as  the  placenta  or  lens.     Postmortem  D.,  birth  of  a 
child  after  the  death  of  the  mother.  , 

Dentition.      (1)    The  cutting  of  the  teeth;   teething.      (2)    The  kind,  num- 
ber, and  arrangement  of  the  teeth.     Primary  D.,  the  eruption  of  the 
deciduous    or  milk  teeth.      Secondary  D.,   the   eruption   of   second   or 
permanent  teeth. 
Dermoid    (der'moid).       (1)    Resembling    the    skin.       (2)    A    form    of    con- 
genital   cyst,    chiefly    ovarian,    containing    hair,    skin,    teeth,    etc. ;    a 
dermoid  cyst.     See  Cyst. 
Dessertspoon.     A  measure  about  equal  to  two  fluiddrams. 
Detritus    (de-tri'tus).     The  remains   of   any  broken-down  tissue. 
Deuteroplasm    (du'ter-o-plazm).      The   nutritive    part    of    the    yolk    of    an 

ovum. 
Deutoplasm    (du'to-plazm).      See  Deuteroplasm. 

Diameter.  A  straight  line  through  a  center,  joining  opposite  points  of  a 
periphery-  Anteroposterior  D.  (of  pelvic  inlet).  (1)  That  which 
joins  the  antero-posterior  angle  of  pelvic  inlet;  that  which  joins  the 
sacrovertebral  angle  with  the  symphysis  pubis.  (2)  (Of  pelvic  out- 
let). Joins  tip  of  coccyx  to  suprapubic  ligament.  Antero-transverse 
D  Temporal  D.,  between  tips  of  alae  magna?.  Baudelocque's  D.,  the 
external  conjugate  diameter  of  pelvis.  Biparietal  D.  joins  the 
parietal  eminences.  Bitemporal  D.,  that  which  joins  the  extremities 
of  the  coronal  suture.  Conjugate  D.,  the  antero-posterior  diameter 
of  the  pelvic  inlet.  Diagonal  Conjugate  D.  joins  sacrovertebral 
angle  and  subpubic  ligament.  External  Conjugate  D.  connects 
depression  above  spine  of  first  sacral  vertebra  and  middle  of  upper 
border  of  symphysis  pubis.  Fetal  Cranial  Ds.  are  the  occipitomental, 
occipitofrontal,  'suboccipitobregmatic,  cervicobregmatic.  biparietal, 
and  front  omental.  Intercristal  D.,  the  distance  between  the  middle 
points  of  the  iliac  crests.  Mentoparietal  D.,  from  chin  to  vertex. 
Occipitofrontal  D.  joins  the  root  of  the  nose  and  occipital  promi- 
nf-ce       Occipitomental  D.    joins    the   external    occipital   protuberance 


212  Glossary 


and  the  chin.  Parietal  D.,  Postero-transverse  D.,  between  tuberosi- 
ties of  parietal  bones.  Pelvic  D.,  any  diameter  of  the  pelvis. 
Sagittal  D.,  from  glabella  to  external  occipital  protuberance. 
Superior  Sagittal  D.,  between  middle  of  internal  crest  of  frontal 
bone  and  superior  linea  cruciata  of  occipital.  TrachelobregmaHc  D. 
joins  the  center  of  the  anterior  fontanelle  and  junction  of  neck  with 
floor  of  mouth.  Transverse  D.  of  Pelvic  Inlet  connects  the  two 
most  widely  separated  points  of  pelvic  inlet.  Transverse  D.  of  the 
Pelvic  Outlet  joins  the  ischial  tuberosities.  True  Conjugate  D. 
connects  sacrovertebral  angle  with  the  middle  of  most  prominent  part 
of  posterior  aspect  of  symphysis  pubis.  Vertical  D.,  between 
foramen    magnum    and   vertex. 

Diaphoresis  (di"af-o-re'sis).  Perspiration,  and  especially  profuse  per- 
spiration. 

Diaphoretic  (di"af-o-ret'ik).  (1)  Stimulating  the  secretion  of  sweat. 
(2)  A  medicine  that  increases  the  perspiration.  Sedative  D.,  one 
that  acts  by  dilating  the  cutaneous  vessels:  such  as  the  cardiac  seda- 
tives and  nauseants. 

Diaphragm  (di'af-ram).  (1)  The  musculomembranous  partition  that 
separates   the   abdomen  from  the   thorax.      (2)    Any  thin   septum. 

Diaphragmalgia    (di"a-frag-mal' je-ah).      Pain  in   the  diaphragm. 

Diaphragmatic  (di"af-rag-mat'ik).  Pertaining  to  or  of  the  nature  of  a 
diaphragm. 

Diarrhea,  Diarrhoea  (di-ar-re'ah).  Abnormal  frequency  and  liquidity  of 
fecal   discharges. 

Diastase  (di'as-tas).  A  white,  amorphous,  soluble  solid  produced  during 
the  germination  of  seeds,  and  contained  in  malt.  It  converts  starch 
into  dextrin  and  glucose. 

Diblastula  (di-blas' tu-lah).  A  blastula  in  which  the  ectoderm  and  ento- 
derm are  both  present. 

Dicephalus    (di-sef 'al-us).      A  monster-fetus  with  two  heads. 

Dicrotic  (di-krot'ik).  Having  or  pertaining  to  a  double  beat,  as  of  the 
pulse. 

Digital  (dij'it-al).  (1)  Of,  pertaining  to,  or  performed  with,  a  finger. 
(2)   Resembling  the  imprint  of  a  finger. 

Dilator  (di-la'tor).  An  appliance  used  in  enlarging  an  orifice  or  canal 
by  stretching.  Barnes'  D.,  a  rubber  bag  used  in  dilating  the  os 
and  cervix  uteri.  Intrauterine  D.,  an  instrument  for  dilating  the 
uterine  cavity  by  means   of  air  or  water. 

Diplococcus  (dip-lo-kok'kus).  A  form  of  schizomycetes  made  up  of  pairs 
of  cocci  united  or  linked  so  as  to  produce  an  oval  or  oblong  struc- 
ture;  generally  regarded  as  a  genus   of  bacteria. 

Disengagement.  Escape  from  confinement,  especially  the  emergence  of 
the  fetal  head  from  the  vaginal  canal  in  labor,  or  of  an  impacted 
tumor. 

Diuretic  (di-u-ret'ik) .  (1)  Increasing  the  secretion  of  urine.  (2)  A 
medicine  that  promotes  the  secretion  of  urine. 

Divulsion.      The  act   of  separating   or  pulling  apart. 

Divulsor.      An   instrument  for  performing  divulsion   in   the   urethra. 

Douche  (doosh).  A  stream  of  water  directed  against  a  part  or  into  a 
cavity. 

Douglas'  Cul-de-sac  or  Pouch.  A  sac  of  the  peritoneum  which  dips  down 
below  the  posterior  surface  of  the  uterus. 

Douglasitis    (dug-las-i'tis).     Inflammation   of  Douglas'    pouch. 

Ductus  (duk'tus).  Any  passage  or  duct,  as  of  a  gland.  D.  Arterio'sus, 
a  channel  in  the  fetus  from  the  pulmonary  artery  to  the  aorta.  D. 
Venosus,  a  fetal  blood-vessel  connecting  the  umbilical  vein  with  the 
inferior    vena    cava. 

Duipara    (du-ip'ah-rah).      Same  as   Secundipara. 


Glossary  213 


Dysmenorrhea  (dis"men-or-re'ah).  •  Painful  and  difficult  menstruation. 
Congestive  D.,  Plethoric  D.,  that  which  is  accompanied  by  great 
congestion  of  the  uterus.  Inflammatory  D.,  that  which  comes  from 
or  is  due  to  inflammation.  Meclfanic  D.,  that  which  is  due  to 
mechanic  interference  with  the  flow,  as  from  clots  or  flexion  of  the 
uterus.  Membranous  D.,  that  which  is  characterized  by  membranous 
exfoliations  derived  from  the  uterus.  Obstructive  D.,  that  which  is 
due  to  mechanic  obstruction  to  the  discharge  of  the  menstrual  fluid. 
Ovarian  D.,  that  which  is  due  to  ovarian  disease.  Spasmodic  D., 
that  which  is  due  to  spasmodic  uterine  contraction.  Tubal  D., 
that  which  is  due  to  narrowness  or  closure  of  an  oviduct.  Uterine 
D.,  that  which  arises  from  a  uterine  disorder.  Vaginal  D.,  that 
which  is  due  to  a  vaginal  disease. 

Dystocia  (dis-to'se-ah).  Painful  or  slow  delivery  or  birth.  Fetal  D., 
that  which  is  due  to  the  shape,  size,  or  position  of  the  fetus.  Ma- 
ternal D.,  that  which  is  due  to  some  deformity  on  the  part  of  the 
mother.  Placental  D.,  difficulty  in  removing  or  delivering  the 
placenta. 


Ecbolic  (ek-bol'ik).  (1)  Accelerating  or  causing  parturition.  (2)  An 
agent  which  accelerates  labor. 

Eclampsia  (ek-lamp'se-ah) .  A  sudden  attack  of  convulsions,  especially 
one  of  a  peripheral  origin.  Infantile  E.,  eclampsia  of  reflex  origin, 
as  from  worms,  rickets,  fever,  or  diarrhea,  or  from  tempo- 
rary cerebral  congestion.  E.  Nu'tans,  nodding  spasm,  or  salaam 
convulsion.  Puerperal  E.  occurs  at  or  near  the  end  of  pregnancy, 
and  is  often  uremic.  Uremic  E.,  eclampsia  caused  by  uremia  due  to 
retention   in   the   blood   of  products   excreted   in   the   urine. 

Eclampsism  (ek-lamp'sizm) .  Bar's  term  for  puerperal  eclampsia  without 
convulsive    seizures,    but    with    clear    signs    of    blood-intoxication. 

Eclamptic    (ek-lamp'tik).     Pertaining  to  or  of  the  nature  of  eclampsia. 

Eclamptism  (ek-lamp'tizm).  The  condition  due  to  the  auto-intoxication 
incident  to  pregnancy,  and  marked  by  headache,  visual  impairment, 
and  sometimes  by  convulsions. 

Ecto-.     A  prefix  denoting  situated  on,  without,   or  on  the  outside. 

Ectoblast  (ek'to-blast).  (1)  The  ectoderm,  or  epiblast.  (2)  Any  exter- 
nal membrane;  a  cell  wall. 

Ectopic    (ek-top'ic).     Out  of  the  normal  place. 

Edema,  (Edema  (e-de'mah).  Swelling  due  to  effusion  of  Avatery  liquid 
into  the  connective  tissue. 

Egg.  The  animal  ovum,  especially  one  which  is  hatched  outside  the  body. 
E.  Yolk.      See  Yitellus. 

Embolism  (em'bol-izm).  The  plugging  of  an  artery  or  vein  by  a  clot  or 
obstruction  which  has  been  brought  to  its  place  by  the  blood- 
current. 

Embolus  (em'bo-lus).  (1)  A  clot  or  other  plug  brought  by  the  blood- 
current  from  a  distant  vessel  and  forced  into  a  smaller  one  so  as  to 
obstruct  the  circulation.      (2)    The  nucleus   emboliformis. 

Embryectomy  (em-bre-ek'to-me).  Excision  of  the  embryo  in  extra- 
uterine pregnancy. 

Embryo  (ern'bre-o).  The  fetus  in  its  earlier  stages  of  development, 
especially  before  the  end  of  the  third  month. 

Embryogeny    (em-bre-oj'en-e).      The  production  or  origin   of   the   embryo. 

Embryoid     (em'bre-oid).      Resembling    the    embryo. 

Embryologist    (em-bre-ol' o-jist).     An  expert  in  embryology. 

Embryology  (em-bre-ol'o-je) .  The  science  which  treats  of  the  develop- 
ment of  the   embryo. 


214  Glossary 


Embryonal,  Embryonary  (em'bre-o-nal,  em'bre-o-na-re).  Pertaining  to 
the   embryo. 

Embryonic  (em-bre-on'ik).  Pertaining  to  or  in  the  condition  of  being  an 
embryo. 

Embryotomy  (em-bre-of  o-me).  (1)  The  cutting  up  of  a  fetus  fro  facili- 
tate delivery.      (2)    The  dissection  of  embryos  and  fetuses. 

Emmenagogic  (em-mem-ag-oj 'ik).  Pertaining  to  or  aiding  the  process 
of  menstruation. 

Emmenagogue  (em-men  'ag-og).  (1)  Any  agent  which  stimulates  or 
favors  the  menstrual  discharge.  (2)  Aiding  the  function  of  men- 
struation. Direct  E.,  one  that  acts  directly  upon  the  reproductive 
organs,  such  as  apiol,  ergot,  rue  savine,  or  tansy.  Indirect  E.,  one 
which  acts  by  relieving  some  causative  condition. 

Endoblast  (en 'do-blast).  The  endoderm  or  hypoblast;  the  more  internal 
of  the  primary  blastodermic  layers. 

Endoblastic    (en-do-blast 'ik).      Pertaining  to   the   endoblast;    hypoblastic. 

Endometritis  (en"do-me-tri'tis).  Inflammation  of  the  endometrium,  or 
lining  membrane  of  the  uterus.  Endometritis  is  of  various  kinds: 
it  may  be  catarrhal,  croupous,  diphtheritic,  fungous,  gangrenous, 
hemorrhagic,  or  septic.  It  is  cervical  or  corporeal  according  as  it 
affects  the  cervix  or  body  of  the  uterus. 

Enema  (en'em-ah).  A  clyster  or  injection;  a  liquid  thrown  or  to  be 
thrown   into   the  rectum. 

Entoblast  (en'to-blast).  (1)  The  inner  of  the  two  primitive  embryonic 
layers;  the  hypoblast.  (2)  A  cell-nucleolus.  (3)  Any  one  of  the 
segmentational  spheres  whence  the  endodermal  cells  arise. 

Enuresis  (en-u-re'sis).  Involuntary  discharge  of  the  urine.  Nocturnal 
E.,   that  which  occurs  at  night  and  during  sleep. 

Epiblast  (ep'e-blast).  The  ectoderm,  or  outermost  of  the  three  layers 
of  the  blastoderm.  From  it  are  developed  the  epidermis  and  the 
epidermic  tissues,  such  as  nails,  hair,  and  glands  of  the  skin,  the 
nervous  system,  the  external  sense-organs,  as  ear,  eye,  etc.,  and 
the  mucous  membrane  of  the  mouth  and  anus. 

Epiblastic    (ep-e-blas'tik).      Pertaining   to    or    arising    from    the    epiblast. 

Epigaster  (ep-e-gas'ter).  The  hind-gut;  the  embryonic  structure  whence 
tne    colon    is    formed. 

Epigastric    (ep-e-gas' trick).      Pertaining  to  the   epigastrium. 

Epigastrium  (ep-e-gas'tre-um).  The  epigastric  region;  the  upper  mid- 
dle portion  of  the  abdomen,   over  or  in  front  of  the  stomach. 

Ergot  (er'got).  Any  fungus  which  affects  and  finally  replaces  the 
seed  of  a  cereal  grass;  especially  the  sclerotium  of  Clav'iceps 
purpu'rea:  ergot  of  rye.  Ergot  contracts  the  arterioles  and  un- 
striped  muscle-fibers  of  the  uterus,  and  is  a  powerful  ecbolic  and 
hemostatic.  Dose  of  aqueous  and  alcoholic  extracts,  1^—8  gr. 
(0.099-0.533  gm.)  ;  of  fluid  extract,  15-60  min.  (1-4  c.c.)  ;  of  wine. 
1    4    dr.     (4-16    c.c). 

Ergotherapy    (er-go-ther'ap-e).      Treatment   of   disease   by   physical   effort. 

Ergotin  (er-go'tin).  One  of  the  alkaloids  of  ergot;  also  a  proprietary 
ergot-preparation.  Dose  of  alkaloid,  1-15-%  gr.  (0.0042-0.033 
gm.)  ;  of  extract,  3-15  gr.  (0.2-1  gm.).  Bonjean's  E.,  a  purified 
extract    of    ergot. 

Ergotinin  (er-got'in-in).  An  alkaloid,  C35H40N4Oo,  one  of  the  active 
principles  of  ergot.      Styptic  dose,   1-12-1,4    gr.    (0.005-0.016  gm.). 

Ergotism  (er'got-izm).  Chronic  poisoning  from  excessive  or  misdi- 
rected use  of  ergot  as  a  medicine,  or  from  eating  ergotized  grain. 
It  is  marked  by  cerebro-spinal  symptoms,  spasms  and  cramps  or 
by  a  kind  of  dry  gangrene. 

Ergotized     (er'got-Izd).      Diseased     or     otherwise     affected    by     ergot. 

Ergotol  (er'got-ol).  A  liquid  preparation  of  ergot  for  hypodermic  use. 
Dose,   5-20   min.    (0.33-1.33   c.c). 


Glossary  21 5 


Ernutin  (er-nu'tin).  A  proprietary  preparation  said  to  represent  the 
active  therapeutic  principle  of  ergot. 

Ether  (e'ther).  (1)  A  fluid  of  the  utmost  tenuity,  which  is  conceived 
to  fill  all  space  and  to  serve  as  a  medium  for  the  transmission  of 
waves  of  heat  and  light.  Called  also  luminiferous  ether.  (2) 
Ethyl  oxide  (C2HE)0,  a  highly  volatile  liquid,  obtained  by  the  action 
of  strong  sulphuric  acid  upon  ordinary  alcohol. 

Etiology  (e-te-ol'o-je).  The  study  of  the  theory  of  the  causation  of  any 
disease;  the  sum  of  knowledge  regarding  causes. 

Eutocia    (u-to'she-ah).      Safe,   easy,    or  natural  parturition,    or  childbirth. 

Evacuation.  (1)  An  emptying,  as  of  the  bowels.  (2)  A  dejection  or 
stool ;    material    discharged   from    the    bowels. 

Eversion  (e-ver'shun).      A  turning  outward,  or  inside  out. 

Evisceration  (e-vis-er-a'shun).  (1)  Disembowelment ;  removal  of  the 
entrails,  or  viscera.  (2)  Removal  of  the  contents  of  an  organ,  as 
the  eye.  Obstetric  E.,  the  removal  of  the  abdominal  and  thoracic 
viscera  of  the  fetus  in  order  to  facilitate  delivery. 

Evolution.  (1)  An  unrolling.  (2)  A  process  of  development  in  which 
an  organ  or  organism  becomes  more  and  more  complex  by  the  dif- 
ferentiation of  its  parts;  a  continuous  and  progressive  change  ac- 
cording to  certain  laws  and  by  means  of  resident  forces.  Spon- 
taneous E.,  the  unaided  expulsion  of  a  transversely  placed  fetus 
without  the  process  of  version,  or  turning. 

Excitable.      Susceptible  of  stimulation;   responding  to   a  stimulus. 

Excrement.      Fecal  matter;  matter  cast  out  as  waste  from  the  body. 

Excrementitious  (ex"kre-men-tish'us).  Pertaining  to  or  of  the  nature 
•   of  excrement ;   fecal. 

Excreta.  Matters  excreted;  waste  matters;  materials  cast  out  by 
the  body. 

Excrete.  (1)  To  throw  off,  as  waste  matter,  by  a  normal  discharge. 
(2)    Any   excreted   or   discharged  waste   matter. 

Exencephalia  (ex"en-sef-a'le-ah).  Congenital  exposure  of  the  brain  of 
a   teratism. 

Exencephalus  (ex-en-sef 'al-us).  A  monster  having  an  imperfect  cranium, 
with  the  brain  on  the  outside  of  the  skull. 

Exfetation   (eks-fe-ta'shun).      Extrauterine  pregnancy. 

Exogenous  (ex-oj'en-us).  (1)  Growing  by  additions  to  the  outside. 
(2)    Developed  or  originating  outside  the  body. 

Exometritis  (ex"o-me-tr'tis).  Inflammation  of  the  peritoneal  or  outer 
surface    of    the    uterus. 

Extractor.      An  instrument  used  in  drawing  out,  pulling,   or  extracting. 

Extragenital  (ex-trah-jen'it-al).  Lying  or  originating  outside  the 
genital  organs. 

Extraperitoneal  (ex"trah-per-it-o-ne'al).  Situated  or  occurring  outside 
the  peritoneal  cavity. 

Extrauterine  (ex-trah-u'  ter-in) .  Situated  or  occurring  outside  of  the 
uterus. 

Extroversion    (ex-tro-ver'shun).      A  turning  inside  out;   exstrophy. 

F 

Falling  of  the  Womb.  The  abnormal  descent  of  the  uterus  into  the 
vagina. 

Fallopian    (fal-lo'pe-an).      Described   by    or    named    for   Fallopius. 

Fecal    (fe'kal).      Pertaining  to   or  of   the  nature   of  feces. 

Feces  (fe'sez).  The  excrement  or  undigested  residue  of  the  food  dis- 
charged from  the  bowels. 

Fecundation  (fe-kun-da'shun).  Impregnation  or  fertilization.  Artificial 
F.,  that  which  is  effected  by  injecting  semen  into  the  uterus  by 
means  of  a  syringe. 


216  Glossary 

Fecundity    (fe-kun'dit-e).      Ability  to   produce    offspring;    fruitfulness. 

Female.  (1)  Relating  or  belonging  to  the  sex  that  conceives  and  bears 
young.       (2)    Receiving    a    complementary    part. 

Feminilism,  Feminism  (fem-in'il-izm,  fem'in-izm).  The  possession  or 
assumption   of   female   characters   by   the   male. 

Femininity,  Feminity,  Femineity  (fem-in-in'it-e,  fem-in'it-e,  fem-in-e'it-e'). 
Womanhood;    the  possession   of  normal  female   qualities  by  a  woman. 

Fennel  (fen'nel).  The  umbelliferous  plant  Fcenic'ulum  vulga'  re  and 
its  fruit.  The  fruit  is  used  as  a  stimulant,  carminative,  and 
emmenagogue.  Dose,  of  water  (a'qua  fceni'luli),  %  fl.dr.  (4-1 6 
c.c.)  ;    of  volatile  oil,   5-10  min.    (0.33-0.66   gm,). 

Fertile.  Fruitful ;  susceptible  of  being  developed  into  a  new  individual 
(of   ova)  ;    not   sterile   or  barren. 

Fetal   (fe'tal).      Pertaining  to  a  fetus. 

Fetation  (fe-ta'shun).  (1)  The  development  of  the  fetus.  (2)  Ges- 
tation or  pregnancy. 

Feticide   (fe'tis-Td).      The  destruction  of  the  fetus  in  the  uterus. 

Fetus  (fe'tus).  The  unborn  offspring  of  any  viviparous  animal;  the 
child  in  the  womb  after  the  end  of  the  third  month;  before  that 
time  it  is  called  the  embryo.  Harlequin  F.,  a  fetus  prematurely  born 
and  congenitally  affected  with  keratoma,  ichthyosis,  and  various 
defects.  Papyraceous  F.,  a  dead  fetus  pressed  flat  by  the  growth 
of  a  living  twin.  F.  Sanguinolen'tus,  a  dead  fetus  which  has  under- 
gone what  is  known  as  maceration. 

Fibroid  (fi'broid).  (1)  Resembling  a  fibroma  or  a  fibrous  structure. 
(2)    A  fibroma. 

Fibroma  (fi-bro'mah).  A  tumor  composed  mainly  of  fibrous  or  fully 
developed   connective   tissue. 

Fillet  (fil'let).  (1)  A  loop-shaped  structure.  (2)  A  loop,  as  of  cord 
or  tape,  for  making  traction. 

Fimbria  (fim'bre-ah).  A  fringe;  especially  the  fringe-like  end  of  the 
oviduct.      F.  Ova'rica,  the  longest  of  the  fimbriae  of  the  oviduct. 

Fimbriate,  Fimbriated   (fim'bre-at,  fim'bre-a-ted).      Fringed. 

Fimbriatum   (fim-bre-a'tum).      The  corpus  fimbriatum. 

Flatulence  (flat'u-lens).  Distention  of  the  stomach  or  intestines  with  air 
or  gases. 

Flatulent    (flat'u-lent) .      Characterized  by  flatulence;    distended  with  gas. 

Flatus  (fla'tus).  (1)  Gas  or  air  in  the  stomach  or  intestines.  (2) 
The  air  expired  in  breathing;  an  act  of  expelling  air  from  the 
lungs.      F.  Vagina'lis,  noisy  expulsion  of  gas  from  the  vagina. 

Flexion.     The  act  of  bending  or  condition  of  being  bent.    ' 

Flow.  (1)  To  menstruate  copiously.  (2)  A  free  liquid  discharge.  (3) 
The  menses. 

Foetal,  Foetus,  etc.      See  Fetal,  Fetus,  etc. 

Follicle  (fol'lik-1).  A  very  small  excretory  or  secretory  sac  or  gland. 
Graafian  F.,  any  one  of  the  small  spherical  ovarian  bodies,  each  one 
of  which  contains  an  ovum.  Naboth's  Fs.,  distended  mucous  glands 
within    the   cervix   and   about   the   os   uteri. 

Fontanel,  Fontanelle  (f  on-tan-el ' ) .  Any  one  of  the  unossified  spots 
on  the  cranium  of  a  young  infant.  Anterior  F.  is  situated  at  the 
junction  of  the  frontal,  coronal,  and  sagittal  sutures.  Posterior  F.  is 
at  the  junction  of  the  sagittal  suture  and  lambdoid  sutures. 

Foramen  (for-a'men);  A  hole  or  perforation;  especially  a  hole  in  a 
bone.  F.  Ova'le.  (1)  A  fetal  opening  between  the  heart's  auri- 
cles. (2)  An  aperture  in  the  wing  of  the  sphenoid  bone  for 
the   inferior   maxillary   nerve   and   the   small   emningeal   artery. 

Forceps  (for'seps).  An  instrument  with  two  blades  and  handles  for 
pulling,    grasping,    or   compressing. 


Glossary  217 

Formaldehyde  (formal' de-hid).  Formic  aldehyde,  a  powerfully  dis- 
infectant gas,  CH20.  The  gas  is  used  as  a  disinfectant  for  rooms, 
clothing,  etc.  The  aqueous  solution  is  a  colorless,  volatile  fluid, 
used   as   a   surgical    and   general    antiseptic   and  preservative. 

Formalin  (for'mal-in).  A  40  per  cent  solution  of  gaseous  formaldehyde. 
It  is  used  as  an  antistpt.c  and  disinfectant  in  1:2000  to  1:200 
solutions,    and    as    a    fixing    agent    in    histologic    work. 

Fornix  (for 'nix).  Posterior  F.,  the  deep  recess  between  the  cervix 
uteri  and  the  posterior  wall  of  the  vagina. 

Fossa  (fos'sah).  A  pit,  depression,  trench,  fovea,  or  hollow.  F.  Navic- 
ula'ris.  (1)  A  cavity  behind  the  vaginal  aperture.  (2)  An  ex- 
pansion of  the  urethra  in  the  glans  penis. 

Frenulum,   Frasnum,   etc.      See  Frenulum,   Frenum,   etc. 

Frenulum,  Fraenulum  (fren'u-lum).  A  small  frenum.  F.  Puden'di,  the 
fourchet. 

Frenum,  Frsenum  (fre'num).  A  fold  of  the  integument  or  of  the  mucous 
membrane  that  checks,  curbs,  or  limits  the  movements  of  an  organ 
in  part.  Frsena  Labio'rum,  folds  of  mucous  membrane  on  the  inside 
of  the  middle  of  each  lip,  connecting  the  lips  with  the  gums.  F. 
Lin'guse,  a  vertical  fold  of  mucous  membrane  under  the  tongue. 
F.  of  the  Prepuce,  the  fold  on  the  lower  surface  of  the  glans  penis 
that  connects  it  with  the  prepuce.      F.  Puden'di,  the  fourchet. 

Fumigation.      Exposure  to  disinfecting  fumes. 

Fundal    (fun'dal).      Pertaining   to    a    fundus. 

Fundus  (fun'dus).  The  base  or  part  of  a  hollow  organ  remotest  from  its 
mouth.  F.  U'teri,  that  part  of  the  uterus  which  is  most  remote 
from  the  os.      F.  Vesi'cae,  the  bas  fond  of  the  urinary  bladder. 

Funic    (fu'nik).      Pertaining    to    the    funis. 

Funiculus    (fu-nik'u-lus).      The  umbilical   cord,    or  funis. 

Funis    (fu'nis).      The   umbilical    cord. 

Fusion.  (1)  The  act  or  process  of  melting.  (2)  The  abnormal  co- 
herence   of   adjacent   parts    or  bodies. 


G 

Galactagogue  (gal-ak'tag-og).  (1)  Increasing  the  secretion  of  milk. 
(2)    An   agent   that   promotes   the   flow    of   milk. 

Galactemia,  Galactaemia  (gal-ak-te'me-ah).  A  morbid  condition  of  the 
blood  in  which   it   contains   milk. 

Galactocele  (gal-ak'to-sel).  (1)  A  cystic  enlargement  of  the  mammary 
gland   containing   milk.       (2)      A   hydrocele   filled   with   a   milky   fluid. 

Galactophoritis    (gal-ak"tof-or-i'tis) .      Inflammation   of   the   milk-ducts. 

Galactophorous   (gal-ak-tof '  or-us).      Conveying  milk. 

Galactorrhea,  Galactorrhoea  (gal-ak-tor-rhe'ah).  Excessive  secretion 
of  milk. 

Galactoscope  (gal-ak' to-skdp).  A  device  for  showing  the  proportion  of 
cream  in  the  milk. 

Gauze.  A  light,  open-meshed  variety  of  muslin  or  similar  material. 
Before  use  in  surgery  it  may  be  rendered  aseptic  and  impregnated 
with  various  antiseptics,  as  iodoform  gauze,  borated  gauze,  sub- 
limated gauze,   etc.,   or  subjected  to  steam  or  heat  for  sterilization. 

Genesis    (jen'es-is).      Reproduction;   origin;   development. 

Genital.      Pertaining  to  the  organs  of  generation  or  to  reproduction. 

Genitalia    (jen-it-a'le-ah).      The    reproductive    organs. 

Genito-urinary  (jen"it-o-u'rin-er-e).  Pertaining  to  the  genital  and 
urinary  organs. 

Germicidal    (jer-mis-i'dal).      Destructive    to    germs. 

Germicide    (jer'mis-Td).      An  agent  that  destroys  germs. 


218  Glossary 

Germifuge  (jer'mif-uj).  (1)  Having  the  power  to  expel  germs.  (2) 
An  agent  or  remedy  that  expels  germs. 

Germinal    (jer'min-al).      Pertaining  to  or  of  the  nature  of  a  germ. 

Germination  (jer-min-a'shun).  The  sprouting  of  a  seed  or  spore,  or  of 
a    plant-embryo. 

Germinative    (jer'min-at-iv).      Pertaining  to  germination  or  to  a  germ. 

Gland.  An  organ  that  separates  any  fluid  from  the  blood:  such  ductless 
bodies  as  the  spleen,  the  lymphatic  organs,  etc.,  which  do  not  appear 
to  secrete  anything,  are  also  called  glands.  G.  of  Bartholin,  the 
vulvo-vaginal  gland.  Montgomery's  Gs.,  sebaceous  glands  of  the 
mammary  areola.  Uterine  Gs.,  tubular  glands  of  the  endometrium. 
Vaginal  G.,  any  gland  of  the  vaginal  mucous  membrane.  Vulvo- 
vaginal G.,  a  minute  gland  on  either  side  of  the  vagina,  with  a 
duct    opening   near   the    nymphse. 

Goiter,  Goitre  (goi'ter).  Enlargement  of  the  thyroid  body,  causing  a 
swelling  in  the  front  part  of  the  neck;   bronchocele. 

Gonococcus  (gon-o-kok'kus).  A  bacterial  coccus,  the  specific  agent 
of    gonorrhea;    the    micrococcus    gonorrhoea. 

Gonorrhea,  Gonorrhoea  (gon-or-re'ah).  A  contagious  catarrhal  inflam- 
mation of  the  genital  mucous  merabraift,  mainly  propagated  by 
impure  coitus,  and  due  to  a  specific  microorganism,  the  gonococcus 
of   Neisser. 

Graafian  Follicle,   Vesicles,   etc.      (graf'fe-an).     See  Follicle,  Vesicle,   etc. 

Gutta.  A  minute  spherical  mass  of  liquid:  assumed  to  be  equal  to  a 
minim  (q.  v.).  G.-Percha,  the  concrete  juice  of  Isonan'dra  gut'ta, 
a  tree  of  Sumatra,  etc.,  much  used  in  surgery,  etc.  G.  Rosa'cea. 
Same  as  acne  rosacea.      G.   Sere'na,   amaurosis. 

Gynaecology    (jin-e-kol'o-je).      See   Gynecology. 

Gynecologic,  Gynecological  (jin-e-ko-lo'jik,  jin-e-ko-loj '  ik-al).  Pertain- 
ing   to    gynecology. 

Gynecologist    (jin-e-kol'o-jist).      A  person  skilled  in  gynecology. 

Gynecology  (jin-e-kol'o-je).  That  branch  of  medicine  which  treats  of 
women's    constitution    and    diseases. 


H 

Hematoma  (hem-at-o'mah).  A  tumor  containing  effused  blood.  Pelvic 
H.,  an  effusion  of  blood  into  the  pelvic  cellular  tissue.  Retro-uterine 
H.,  an  effusion  of  blood  into  the  connective  tissue  behind  the  uterus. 

Hematometra  (hem-at-o-me'trah).  An  accumulation  of  blood  in  the 
uterus. 

Hemorrhage,  Haemorrhage  (hem'or-rej).  A  copious  escape  of  blood 
from  the  vessels;  bleeding.  Accidental  H.,  hemorrhage  during  preg- 
nancy, due  to  premature  detachment  of  the  placenta.  Arterial  H., 
the  escape  of  blood  from  an  artery  or  a  ruptured  aneurism. 
Unavoidable  H.,  that  which  results  from  the  detachment  of  a  pla- 
centa   previa. 

Hemorrhoid  (hem'or-roid).  A  pile,  or  vascular  tumor  of  the  rectal 
mucous  membrane.  External  Hs.,  hemorrhoids  situated  outside  the 
sphincter  ani.  Internal  Hs.,  hemorrhoids  situated  within  the 
sphincter  ani. 

Hemorrhoidal  (hem-or-roid'al).  Pertaining  to,  or  of  the  nature  of, 
hemorrhoids. 

Hemosalpinx     (hem-o-sal'pinx).      Dilatation     of    an     oviduct    with    blood. 

Hemostat  (hem'o-stat).  (1)  An  apparatus  or  a  medicine  for  checking 
hemorrhage.  (2)  A  proprietary  remedy  for  nose-bleed,  containing 
tannin,    quinine   sulphate,   lard,    and   benzoic   acid;    used   externally. 

Hernia  (her'ne-ah).  The  protrusion  of  a  loop  or  knuckle  of  an  organ 
or  tissue  through  an  abnormal   opening. 


Glossary  219 

Hyalin  (hi'al-in).  (1)  A  translucent  albuminoid  substance,  one  of  the 
products  of  amyloid  degeneration.  (2)  A  substance  composing  the 
walls  of  hydatid  cysts. 

Hyaline    (hi'al-in).      Pellucid    or    glassy,    and    transparent    or    nearly    so. 

Hydragogue  (hi'drag-og).  (1)  Producing  watery  discharges,  especially 
from   the   bowels.      (2)    A   cathartic   which   causes   watery   purgation. 

Hydramnion,  Hydramnios  (hi-dram'ne-on,  hi-dram'ne-os).  Dropsy  of  the 
amnion;    excess    of    the    amniotic    fluid. 

Hydrocephalus  (hi-dro-sef 'al-us).  A  fluid  effusion  within  the  cranium. 
The  disease  is  marked  by  enlargement  of  the  head,  with  prominence 
of  the  forehead,  atrophy  of  the  brain,  mental  weakness,  and  con- 
vulsions. 

Hymen  (hi 'men).  The  membranous  fold  which  partially  or  wholly 
occludes  the  external  orifice  of  the  vagina,  at  least  during  virginity. 
H.  Bifenestratus,  H.  Biforis,  a  hymen  with  two  openings  side  by 
side  and  a  board  septum  between  them.  Cribriform  H.,  a  hymen  in 
which  the  opening  is  filled  by  a  membrane  pierced  by  many  small 
perforations.  Denticular  H.,  a  hymen  with  an  opening  which  has 
serrate  edges.  Imperforate  H.,  one  which  completely  closes  the 
vaginal  orifice.  Sculptured  H.,  a  hymen  showing  an  irregularly 
curved  edge,  as  if  carved  out  of  a  thickened  tissue.  H.  Septus,  a 
form  of  hymen  in  which  the  opening  is  divided  by  a  narrow  septum. 
H.  Subseptus,  a  form  of  hymen  in  which  the  opening  is  partially 
filled  by  a  septum  growing  out  of  one  wall  but  not  reaching  the  other. 

Hymenal    (hi'men-al).      Pertaining  to  the  hymen. 

Hymenitis     (hi-men-i'tis).      Inflammation     of    the    hymen. 

Hymenotomy  (hi-men-ot'o-me).  (1)  The  surgical  incision  of  the  hymen. 
(2)    The  anatomy  and  dissection  of  membranes. 

Hypercyesis    (hi"per-si-e'sis).      Superfetation. 

Hyperemesis,  Hyperemia  (hi-per-e'me-ah).     Excessive  vomiting. 

Hyperencephalus  (hi"per-en-sef'al-us).  A  monster-fetus  with  the  brain 
exposed. 

Hyperpyretic    (hi"per-pi-ret'ik).      Excessively   feverish. 

Hyperpyrexia    (hi"per-pi-reks'e-ah).      A  high  degree  of  fever. 

Hypo-.  A  prefix  denoting  a  lack  or  deficiency;  also  a  position  under  or 
beneath. 

Hypoblast  (hi'po-blast).  The  innermost  of  the  layers  of  the  blastoderm, 
or  primitive  embryo ;  the  endoderm.  From  it  are  developed  the 
epithelium  of  the  alimentary  canal  and  of  the  organs  connected 
with   it,   and  that   of  the   air-passages. 

Hypoblastic    (hi-po-blas'tik).      Pertaining  to  the  hypoblast. 

Hypochondria  (hi-po-kon'dre-ah).  (1)  Plural  of  hypochondrium.  (2) 
Same  as  Hypochondriasis. 

Hypochondriasis  (hi"po-kon-dri'as-is).  Morbid  anxiety  about  the  health, 
often    associated    with    a    simulated    disease. 

Hypochondrium  (hi-po-kon'dre-um).  The  upper  lateral  region  of  the 
abdomen   next  below  the   lowest   rib. 

Hysterectomy  (his-ter-ek'to-me).  The  operation  of  excising  the  uterus, 
performed  either  through  the  abdominal  wall  (Abdominal  H.)  or 
through  the  vagina    (Vaginal  H.). 

Hystereurynter  (his-ter-u-rin'ter).  An  instrument  for  dilating  the 
uterus :  a  metreurynter. 


Icterus  (ik'ter-us).  See  Jaundice.  I.  Neonatorum,  the  jaundice  some- 
times  seen  in  newborn   children. 

Implantation.  (1)  The  transfer  of  parts,  as  of  sound  teeth.  (2) 
Grafting,  as  of  the  skin,  nerves,  or  tendons.  (3)  The  introduction 
of    a    solid    medicine   beneath    the    skin. 


220  Glossary 

Impotence,     Impotency      (im'po-tens,     im'po-ten-se).      Lack     of     power; 

chiefly    of    reproductive    power    or    virility. 
Impregnate    (im-preg'nat).       (1)    To    render    pregnant.       (2)    To    saturate 

or   charge   with. 
Impregnation     (im-preg-na'sbun).      (1)    The    act     of    fecundation,     or    of 

rendering     pregnant.       (2)    The     process     or     act     of     saturation;     a 

saturated    condition. 
Inanition    (in-an-ish'un).      Wasting  of  the  body  from  lack   of  food. 
Incubation.      The  period  between  the  implanting  of  an  infectious  disease 

and   its  manifestation. 
Incubator     (in'ku-ba-tor).      An    apparatus    for    rearing    prematurely    born 

children ;    a    couveuse. 
Infant.      A  babe  or  young  child. 

Infanticide   (in-fan'  tis '  id) .      The  murder  or  the  murderer  of  an  infant. 
Infantile.      Pertaining     to     an     infant     or    to     infancy. 
Infantilism    ( in-fan' til-izm).      Marked  retardation   of  mental   and   physical 

development. 
Infirmary    (in-fir' ma-re).      A   hospital   or   institution   where   sick   or   infirm 

persons  are  maintained  or  treated. 
Instrument.      Any    mechanical     tool,     appliance,     or    apparatus. 
Instrumental.      Pertaining  to  or  performed  by  instruments. 
Introitus     (in-tro' it-us).      The     entrance     to     any     cavity     or     space.      I. 

Vagi'nse,   the   entrance  to  the  vagina. 
Involuntary    (in-vol'un-ta-re).      Performed    independently    of    the    will. 
Involution    (in-vo-lu'shun).       (1)    A  rolling   or  turning   inward.       (2)    The 

return    of    the    uterus    to    its    normal    size    after    parturition.       (3)    A 

retrograde    change;    the   reverse   of   evolution. 
Ischiopubic    (is"ke-o-pu'bik).      Pertaining   to  the   ischium   and  pubes. 
Ischiopubiotomy      (is"ke-o-pu-be-ot'e-me).        Obstetric     division     of     the 

ischiopubic  and  horizontal  branches  of  the  os  pubis. 
Ischiorectal    (is"ke-o-rek' tal).      Pertaining  to  the  ischium  and  rectum. 
Ischiosacral   (is"ke-o-sa'kral).      Pertaining  to  the  ischium  and  sacrum. 
Ischiovaginal    (is"ke-o-vaj  'in-al).      Pertaining  to  the  ischium  and  vagina. 
Ischium    (is'ke-um).      The  lower  dorsal  part  of  the  innominate  bone. 
Isthmus     (isth'mus,    ist' mus,    is'mus).      A    narrow    strip    of    tissue    or    a 

narrow  passage   connecting  two  larger  parts. 


Jaundice   (jawn'dis).      Yellowness  of  the  skin,  eyes,  and  secretions,  due  to 

the  presence  of  bile-pigments  in  the  blood. 
Jelly.      A  soft   substance   which   is   coherent,    tremulous,    and   more    or  less 

translucent.     J.    of  Wharton,    the   soft,    pulpy   connective    tissue    that 

constitutes    the    covering    Of    the    umbilical    vessels. 
Junket.      Curds  and  whey,  used  as  food. 
Justo  Major  (jus 'to  ma'jor).     Larger  than  is  normal  or  usual.     J.  Minor, 

smaller  than  is  normal  or  usual. 


K 

Kasagra    (kas-ag'rah).      A   proprietary   aromatic   fluid   extract   of   cascara 

sagrada. 
Kyestein    (ki-es' te-in).      A   film    sometimes    seen    on    stale    urine,    formerly 

believed   to  be  a  sign   of  pregnancy. 


Glossary  221 


Labium  (la'be-um).  A  lip  or  lip-shaped  organ.  L.  Majus,  the  hairy  fold 
of  the  skin  on  either  side  of  the  slit  of  the  vulva.  L.  Minus,  the 
fold  of  mucous  membrane  within  the  labia  majora;    the  nympha. 

Labor.  Childbirth ;  the  bringing  forth  of  a  child.  Artificial  L.,  that 
which  is  facilitated  or  induced  by  mechanic  or  other  extraneous 
means.  Atonic  L.,  that  which  is  protracted  by  atony  of  the  uterus. 
Complicated  L.,  that  in  which  there  occurs  a  hemorrhage,  eclampsia, 
or  some  other  untoward  event.  Dry  L.,  one  in  which  the  liquor 
amnii  escapes  before  the  beginning  of  the  pains.  False  L.,  one  in 
which  no  progress  toward  delivery  is  made.  Induced  L.,  labor 
brought  on  by  artificial  means.  Instrumental  L.,  that  which  is  facili- 
tated by  the  use  of  instruments.  Metastatic  L.,  labor  in  which  the 
contractions  occur  in  some  other  part  than  the  uterus.  Missed  L., 
retention  of  the  dead  fetus  in  utero  beyond  the  period  of  normal 
gestation.  Multiple  L.,  labor  with  two  or  more  fetuses  present. 
Obstructed  L.,  that  in  which  there  is  some  mechanical  hindrance,  as 
from  a  tumor  or  a  contracted  parturient  canal.  Perverse  L.,  that  in 
which  the  child  occupies  an  abnormal  position.  Postponed  L.,  that 
which  takes  place  later  than  the  normal  limit.  Powerless  L.,  that  in 
which  there  is  atony  of  the  uterus.  Precipitate  L.,  that  which  is 
accomplished  with  undue  celerity.  Premature  L.,  labor  taking  place 
before  the  normal  period.  Protracted  L.,  one  which  is  prolonged 
beyond  the  ordinary  limit.  Spontaneous  L.,  one  that  requires  no 
artificial  aid.  Tedious  L.,  parturition  that  is  abnormally  protracted. 
Twin  L.,  tedious  labor  due  to  the  presence  of  two  fetuses. 

Laceration  (las-er-a'shun).  (1)  The  act  of  tearing.  (2)  A  wound 
made  by  tearing. 

Lactagogue    (lak'tag-og).      See  Galactagogue. 

Lactalbumen  (lak-tal-bu'min).  An  albumen  found  in  milk  and  resembling 
serum -albumen. 

Lactation  (lak-ta'shun).  (1)  The  secretion  of  milk.  (2)  The  period  of 
the  secretion  of  milk.      (3)    Suckling. 

Lacteal  (lak'te-al).  (1)  Pertaining  to  milk.  (2)  Any  one  of  the  intes- 
tinal lymphatics  that  take  up  chyle. 

Lactiferous    (lak-tif 'er-us).     Producing  or  conveying  milk. 

Lactone  (lak'ton).  (1)  An  aromatic  fluid  (CioHsOjJ  prepared  by  distilla- 
tion from  lactic  acid.  (2)  Tablets  containing  lactic  acid  bacteria, 
used  in  preparing  buttermilk. 

Lactose  (lak'tds).  Milk-sugar  (CioHooOu  +  H20),  a  white  crystalline 
sugar  found  in  milk.  It  is  soluble  in  water,  and  is  used  mainly  as  a 
vehicle  for  medicines. 

Lambda  (lam'dah).  The  point  at  the  site  of  the  posterior  fontanelle 
where  the  lambdoid  and  sagittal   sutures   meet. 

Lambdoid    (lam'doid).  Shaped    somewhat    like    the    Greek    letter    A    or    \. 

Lanolin  (lan'o-lin).  Adeps  lana?  hydrosus.  or  rectified  wool-fat:  used  as 
an  excipient  for  remedies  for  external  use. 

Lanugo  (lan-u'go).  (1)  The  fine  hair  on  the  body  of  the  fetus.  (2)  The 
fine  downy  hair  found  on  nearly  all  of  the  body  except  the  palms  and 
soles. 

Laparosalpingectomy  (lap"ar-o-sal-pin-jek'to-me).  Removal  of  an  oviduct 
by  abdominal  section. 

Laparotomize    (lap-ar-ot  'em-Tz).      To  perform   laparotomy   upon. 

Laparotomy  (lap-ar-ot '  o-me).  Surgical  incision  through  the  flank;  less 
correctly,  abdominal  section  at  any  part. 

Lavage  (lah-vahzh').  The  irrigation  or  washing  out  of  an  organ,  such  as 
the  stomach  or  bowel. 

Laxol  (lax'ol).  Castor  oil  prepared  with  saccharine  and  oil  of  pepper- 
mint. 


222  Glossary 

Linea  (lin'e-ah).  The  tendinous  mesial  line  down  the  front  of  the  abdo- 
men. L.  Albican  'tes,  the  white  abdominal  lines  seen  during  and 
after  pregnancy ;  striae. 

Lithopedion  (lith-o-pe'di-on).  A  dead  fetus  that  has  become  stony  or 
petrified. 

Lochia  (lo'ke-ah).  The  vaginal  discharge  that  takes  place  during  the 
first  week  or  two  after  childbirth.  L.  Al'ba,  the  whitish  discharge 
normal  after  about  the  first  six  days  after  childbirth.  L.  Cru'enta, 
L.  Ru'bra,  the  reddish  sanguineous  flow  of  the  first  week  after  de- 
livery.    L.  Serosa,  a  serous  or  ichorous  lochial  discharge. 

Lochial   (lo'ke-al).     Pertaining  to  the  lochia. 

Lochiometra  (lo"ke-o-me'trah).  The  retention  or  non-discharge  of  the 
lochia. 

Lochiometritis    (lo"ke-o-me-tri' tis).     Puerperal  metritis. 

Lochiorrhagia    (lo"ke-or-ra' je-ah).      Same  as  Lochiorrhea. 

Lochiorrhea,  Lochiorrhcea  (lo"ke-or-re'ah).  An  abnormally  free  lochial 
discharge. 

L.  M.  A.  Abbreviation  for  left  mento-anterior  position  of  the  fetus  in 
utero. 

L.  M.  P.  Abbreviation  for  left  mentoposterior  position  of  the  fetus  in 
utero. 

L.  O.  A.  Abbreviation  for  left  occipito-anterior  position  of  the  fetus  in 
utero. 

L.  O.  P.  Abbreviation  for  left  occipito-posterior  position  of  the  fetus  in 
utero. 

L.  S.  A.  Abbreviation  for  left  sacro-anterior  position  of  the  fetus  in 
utero. 

L.  S.  P.  Abbreviation  for  left  sacro-posterior  position  of  the  fetus  in 
utero. 

M 

Macrocephalia,  Macrocephaly  (mak"ro-sef-a'le-ah,  mak-ro-sef'al-e).  Ex- 
cessive size  of  the  head. 

Macrocephalous   (mak-ro-sef  'al-us).     Having  an  excessively  large  head. 

Malpresentation  (mal"prez-en-ta'shun).  A  faulty,  abnormal,  or  untoward 
fetal  presentation. 

Mammary   (mam'ar-e).     Pertaining  to  the  mamma. 

Mammilla,  Mamilla  (mamil'lah).  The  nipple;  also  any  nipple-like 
structure. 

Mammillary   (mam'il-la-re) .     Like  or  pertaining  to  a  nipple. 

Mania.  A  variety  of  insanity  characterized  by  wild  excitement,  halluci- 
nations, delusions,  and  violent  tendencies;  insanity  with  exaltation, 
as  distinguished  from  melancholia,  or  insanity  with  depression. 
Puerperal  M.,  the  insanity  which  sometimes  follows  cnildbirth. 

Manikin.  A  model  of  the  body,  with  movable  members  or  parts,  used  to 
illustrate  anatomy.  Obstetrical  M.,  a  model  of  the  pelvic  region  to 
illustrate  mechanism  of  labor. 

Masseur  (mahs-ser').  (1)  A  man  who  performs  massage.  (2)  An  instru- 
ment for  performing  massage. 

Masseuse   (mahs-suhz' ).     A  woman  who  performs  massage. 

Mastadenitis   (mas"tad-en-i' tis) .     Inflammation  of  the  mammary  gland. 

Mastalgia   (mas-tal' je-ah).     Pain  in  the  mammary  gland. 

Mastatrophia,  Mastatrophy  (mas-tat-ro'fe-ah,  mas-tat '  ro-fe).  Wasting 
away,   or  atrophy,   of  the  mammary  gland. 

Mastitis  (mas-ti'tis).  Inflammation  of  the  breast;  particularly  inflamma- 
tion of  the  mammary  gland.  Interstitial  M.,  inflammation  of  the 
stroma  of  the  mammary  gland.  Parenchymatous  M.,  inflammation  of 
the  glandular  substance  of  the  breast.  Phlegmonous  M.,  nbxress  of 
the  breast. 


Glossary  223 


Mastorrhagia    (mas-to-ra' je-ah).      Sudden  hemorrhage   from  the  mammary 

gland. 
Maternal.     Pertaining  to  the  mother. 
Maternity.      (1)   Motherhood.      (2)   A  lying-in  hospital. 

Maturation    (mat-u-ra'shun).      The  stage  or  process  of  becoming  mature. 
Mature.     Ripe  ;  fully  developed. 

Meconium  (me-ko'ne-um) .  The  first  fecal  matter  discharged  by  the  new- 
born. It  is  a  dark-green  substance,  consisting  of  mucus,  bile,  and 
epithelial  threads.  . 
Membrane.  A  thin  layer  of  tissue  which  covers  a  surface  or  divides  a 
space  or  organ.  Mucous  M.,  a  membrane  composed  of  epithelium 
upon  a  basement-membrane  with  a  subcutaneous  tissue,  lining  those 
canals  and  cavities  of  the  body  which  communicate  with  the  external 
air,  such  as  the  alimentary  canal  and  its  branches,  the  respiratory 
tract  and  its  connections,  and  the  genito-urinary  tract.  Serous  M., 
the  lining  membrane  of  any  one  of  the  great  splanchnic  or  lymph- 
cavities. 

Menopause.  The  period  when  menstruation  normally  ceases ;  the  change 
of  life. 

Menses.  The  monthly  flow  of  blood  from  the  genital  tract  of  women, 
attended  with  congestion  of  the  genital  tract  and  hypertrophy  of  the 
uterine  mucous  membrane.  It  attends  the  discharge  of  ova  from 
the  ovary. 

Menstrual.     Pertaining  to  the  menses. 

Menstruation.  The  monthly  sanguineous  discharge  peculiar  to  women; 
the  recurrence  of  the  menses.  It  begins  at  the  age  of  puberty 
(twelve  to  seventeen  years)  and  extends  to  the  menopause.  Climac- 
teric M.,  the  time  or  epoch  of  the  last  menstruation.  Vicarious  M., 
a  menstrual  flow  from  some  part  or  organ  other  than  the  vagina. 

Mento-anterior    (men"to-an-te're-or).     Having  the  chin  directed  forward. 

Mento-posterior  (men"to-pos-te're-or).  Having  the  chin  directed  toward 
the  back,  or  turned  sacrad   (used  of  the  fetus  at  delivery). 

Mentum  (men 'turn).     The  chin. 

Mesometrium  (mes-o-me'tre-um) .  (1)  The  middle  layer  of  the  uterus; 
the  myometrium.      (2)    The  broad  ligaments. 

Mesorectum  (mes-o-rek'tum).  The  mesentery  of  the  rectum;  the  fold 
of  peritoneum  connecting  the  upper  portion  of  the  rectum  with  the 
sacrum. 

Mesosalpinx  (mes-o-sal'pink).  The  peritoneal  fold  that  suspends  the 
oviduct. 

Metra   (me'tah).      The  uterus  or  womb. 

Metratome    (me'trah-tom).     An  instrument  for  cutting  the  uterus. 

Metritis  (me-tri'tis).  Inflammation  of  the  womb.  Several  varieties  are 
named,  according  to  the  part  of  the  organ  affected — cervical,  cor- 
poreal, interstitial,   and  parenchymatous. 

Metrocele     (me'tro-sel).      Hernia    of    the    uterus. 

Metrodynia     (me-tro-din'e-ah) .      Pain    in    the    uterus. 

Metro-endometritis  (me"tro-en"do-me-tri'tis).  Combined  inflammation  of 
the  uterus  and  its  mucous  membranes. 

Metrorrhagia    (me-tror-ra' je-ah) .      An  abnormal  uterine  hemorrhage. 

Metrorrhea  (met-ror-re'ah).     A  free  or  abnormal  uterine  discharge. 

Metrorrhexis    (met-ror-rex'is).     Rupture  of  the  uterus. 

Micro-.      A  prefix  signifying  small. 

Microbacteria  (mi-kro-bak-te're-ah).  A  class  of  bacteria  practically  the 
same  as  bacterium. 

Microbe.  Any  individual  microorganism ;  a  microphyte  or  microzoon : 
chiefly  used  as  a  synonym  of  vegetable  microorganism. 

Micrococcus  (mi-kro-kok'kus).  (1)  A  minute  bacterial  coccus  or  cell 
form.  (2)  A  genus  of  schizomycetes,  the  individuals  of  which  have 
a  spheric  shape. 


22-t  Glossary 

Microscopic,  Microscopical  (mi-kro-skop'ik,  mi"kros-kop'ik-al).  Per- 
taining to  or  visible   only  by   the  aid  of  the   microscope. 

Micturition    (mik-tu-rish'un).     The  passage  of  urine. 

Migration.  (1)  An  apparently  spontaneous  change  of  place.  f2)  The 
movement  of  leucocytes  through  the  walls  of  the  vessels.  M.  of  the 
Ovum,    the   passage   of   the   ovum    from   the   ovary. 

Milk.  The  fluid  secretion  of  the  mammary  gland  forming  the  first  food 
of  young  animals.  Adapted  M.,  milk  specially  modified  so  as  to 
adapt  it  to  the  child's  digestive  capacity.  After-M.,  the  stripping, 
or  last  milk  taken  at  any  one  milking.  Butter-M.,  milk  from  which 
the  butter  fat  has  been  removed  by  churning.  Condensed  M.,  milk 
which  has  been  partly  evaporated;  usually  sweetened  with  sugar  for 
preservation.  Diabetic  M.,  milk  containing  a  small  percentage  of 
lactose.  Fore-M.  (1)  The  first  milk  that  is  taken  at  any  milking. 
(2)  Same  as  Colostrum.  Modified  M.,  milk  in  which  the  percentage 
of  fat.  proteid  and  sugar  content  has  been  changed  to  meet  the  re- 
quirement of  the  individual  child:  used  for  infant  feeding.  Yoghurt 
M.,  a  form  of  sour  milk  used  in  Bulgaria  and  containing  lactic  acid 
bacilli,  the  most  important  of  which  is  the  Bacillus  Bulgaricus.  It 
is  used  in  fermentive  conditions  of  the  digestive  tract.  M.  Leg,  see 
Phlegmasia. 

Minim  (min'im).  One-sixtieth  part  of  a  fluiddram;  often  used  as  a 
synonym   of   drop. 

Misce    (mis'se).      Latin   for  mix. 

Molimen  (mo-li'men).  A  natural  and  normal  effort  made  for  the  per- 
formance of  any  function;  especially  the  monthly  effort  to  establish 
the  menstrual  flow:   the  Menstrual  M. 

Monocephalus  (mon-o-sef 'al-us).  A  monster-fetus  with  two  bodies  and 
one  head. 

Montgomery's   Glands.      See  Gland. 

Morbid.      Pertaining  to   or  affected   with   disease;    diseased. 

Morbidity.  (1)  The  condition  of  being  diseased  or  morbid.  (2)  The 
sick-rate,   or  proportion   of  disease   to  health,   in   a   community. 

Mortal.  Subject  to  death,  or  destined  to  die.  (2)  Fatal;  causing  or 
terminating  in   death. 

Mortality.      (1)    The  quality  of  being  mortal.      (2)    The  death-rate. 

Morula  (mor'u-lah).  The  segmented  ovum  in  the  mulberry  stage,  form- 
ing a   solid  mass  of  cells. 

Morulation    ( morn-la 'shun).      The  process   of  formation   of  the   morula. 

Mother.      The    female    parent. 

Multigravida  ( mul-te-grav'  id-ah) .  A  woman  who  has  often  been  preg- 
nant. 

Multipara    (mul-tip'ar-ah).      A    woman    who   has   borne    several    children. 

Multiparity    (mul-tip-ar' it-e) .      The   condition    of  being   a   multipara. 

Multiparous    (mul-tip'ar-us).      Having  given  birth  to   several   children. 

Muscle.  An  organ  which  by  contraction  produces  the  movements  of  an 
animal  organism.  Muscles  are  of  a  compound  fibrous  tissue,  chemi- 
cally characterized  by  the  presence  of  syntonin,  or  muscular  fibrin., 
and  endowed  with  the  property  of  contractility.  They  are  of  two 
varieties:  striated  or  striped,  including  all  the  muscles  in  which 
contraction  is  voluntary,  and  the  heart-muscle ;  unstriated,  smooth,  or 
organic,  including  all  the  involuntary  muscles  except  the  heart,  such 
as    the    muscular    layer    of    the    intestines,    bladder,    blood-vessels,    etc. 

N 

Nabothian    (na-bo'the-an).      Described    by    or    named    in    honor    of    Martin 

Naboth.     See  under   Follicle. 
Nates    (na'tez).      The  buttocks. 
Nausea    (naw'se-ah).      Tendency   to   vomit;    sickness   at   the   stomach. 


Glossary  225 


Navel.      The  umbilicus.     N.-Ill.,  see  Omphalophlebitis,   2d  def.     N. -String, 

the   umbilical   cord. 
Navicular    (na-vik'u-lar).      (1)    Boat-shaped.      (2)    The   scaphoid  bone   of 

the    tarsus.      Fossa    Navicularis,    boat-shaped    depression    at    junction 

of  labia  majora  and  minora  posteriorly. 
Necropsy    (nek'rop-se).     A  postmortem  examination;   autopsy. 
Necroscopy    (ne-kros'ko-pe) .      A  postmortem   examination. 
Nephritis    (nef-ri'tis).      Inflammation  of  the  kidney. 

Nervous.      (1)   Pertaining  to  a  nerve  or  to  nerves.      (2)    Unduly  excitable. 
Nervousness.      Morbid   or  undue   excitability;    a   state   of   excessive   irrita- 
bility,  with  great  mental   and  physical  unrest. 
Nonigravida    (no-ne-grav'id-ah).      A  woman  pregnant   for  the   ninth   time. 
Nonipara    (no-nip 'ar-ah).      A  woman  who  has  borne  nine   children. 
Non-viable    (non-vi'ab-1).     Not  capable  of  living;   used  of  the  fetus  after 

delivery. 
Nosencephalus    (no-sen-sef  'al-us).     A  fetus  with  a  defective  cranium  and 

brain. 
Notencephalocele    (no"ten-se-fal '  os-el).      Hernial    protrusion    of    the    brain 

from  the  back  of  the  head. 
Nucleolus    (nu-kle'o-lus) .      A   nucleus-like   body    within    the    nucleus    of    a 

cell.      Secondary   N.,    a   mass    sometimes    seen   near   a   nucleolus,    and 

looking  like  a  separated  portion   of  the  latter. 
Nucleus    (nu'kle-us).       (1)    A   spheroid   body   within   a   cell,    forming   the 

essential  and  vital  part.     It  is  distinguished  from  the  rest  of  the  cell 

by   its    denser   structure   and  by   containing   nuclein.      It    is    made   up 

of    a    network    of    threads     (chromatin)     contained    in    a    clear    liquid 

(achromatin) . 
Nullipara    (nul-lip' ar-ah).     A  woman  who  has  never  borne  a  child. 
Nulliparity    (nul-lip-ar'it-e).      The   condition   or   fact   of  being  nulliparous. 
Nulliparous    (nul-lip'ar-us).     Having  never  given  birth  to  a  child. 
Nutrient.      Nourishing;   affording  nutriment. 
Nutrition.      (1)   The  process  of  assimilating  food.      (2)    Nutriment. 


Oblique.  Slanting;  inclined;  between  a  horizontal  and  perpendicular 
direction. 

Obstetric,  Obstetrical  (ob-stet'rik,  ob-stet'rik-cal).  Pertaining  to  mid- 
wifery. 

Obstetrician    (ob-stet-rish'un) .      One  who  practices    obstetrics. 

Obstetrics  (ob-stet'riks).  The  art  of  managing  childbirth  cases;  that 
branch  of  surgery  which  deals  with  the  management  of  pregnancy 
and    labor. 

Obstipation    (ob-stip-a'shun).      Intractable    constipation. 

Occipital    (ok-sip'it-al).      Pertaining   to   the    occiput. 

Occipito-anterior  (ok-sip"it-o-an-te're-or).  Having  the  occiput  directed 
ventrad    (used  of  the  fetus  at  the  time   of  labor). 

Occipitobregmatic  (ok-sip"it-o-breg-mat'ik).  Pertaining  to  the  occiput 
and   the  bregma. 

Occipitofrontal  (ok-sip"it-o-fron'tal).  Pertaining  to  the  occiput  and 
the  forehead. 

Occipitoparietal  (ok-sip"it-o-par-i'et-al).  Pertaining  to  the  occipital 
bones   or  lobes. 

Occipitoposterior  (ok-sip"it-o-pos-te're-or).  Having  the  occiput  directed 
dorsad    (used  of  the  fetus  in  labor). 

O.  L.  P.  An  abbreviation  for  occipito-larvo  posterior,  or  the  left  occipito- 
posterior  position    of   the    fetal    head   in   labor. 

Omphalic    (om-fal'ik).      Pertaining   to    the   umbilicus. 

Omphalitis    (om-fal-i'tus).      Inflammation   of  the  navel. 

Omphalocele    (om-fal'o-sel).      An   umbilical    hernia. 


226  Glossary 

Omphalomesenteric  (om"fal-o-mes-en-ter'ik).  Pertaining  to  the  navel 
and  mesentery. 

Omphalophlebitis  (om"fah-lo-fle-bi'  tis).  (1)  Inflammation  of  the  um- 
bilical veins.  (2)  Navel-ill;  a  condition  of  markedly  suppurative 
lesions   in  young  animals  due  to   infection  through   the   umbilicus. 

Omphalotomy    (om-fal-ot'o-me).      The   cutting  of  the  navel-string. 

Ooblast    (o'o-blast).      The    cell   whence   the    ovum   is    developed. 

Oocyesis    (o"o-si-e'sis).      Ovarian   pregnancy. 

Oogenesis    (o-o-jen' is-is).      The   origin  and  development   of  the   ovum. 

Oophoron    (o-of 'o-ron).      An   ovary. 

Oosperm    (o'os-perm).      The   recently   fertilized   ovum. 

Ophthalmia  (of-thal'me-ah).  Severe  inflammation  of  the  eye  or  of  the 
conjunctiva.      O.  Neonato'rum,  purulent  blennorrhea  of  the  newborn. 

Os.  O.  Exter'num,  the  orifice  of  the  vagina,  O.  U'teri  Exter'num, 
O.  Tin'cse,  the  lower  or  distal  extremity  of  the  canal  of  the  cervix 
uteri.  O.  U'teri  Inter 'num,  the  internal  or  upper  orifice  of  the 
canal   of   the   cervix   uteri. 

Oviduct  (o've-dukt).  The  duct  passing  from  either  uterine  cornu  to  the 
ovary,  and  serving  to  convey  the  ovum  from  the  ovary  to  the  uterus 
and  spermatozoa   to  the   ovary;    a   Fallopian  tube. 

Oviferous    (o-vif  er-us).      Producing    ova. 

Ovification  (o"vif-ik-a'shun).  The  formation  of  the  ovum  in  the  ovary; 
ovulation. 

Ovisac  (o'vis-ak).  A  Graafian  vesicle;  the  structure  which  holds  an 
ovum   while   still    within    the    ovary. 

Ovule  (o'vTTl).  (1)  The  ovum  within  the  Graafian  vesicle.  (2)  Any 
small  egg-like  structure.  O.  of  DeGraaf,  a  Graafian  vesicle. 
Naboth's  Os.,  glandules  or  follicles  within  the  os  uteri  and  cervical 
canal,  often  distended  with  mucus.  Primitive  O.,  Primordial  0.,  a 
rudimentary   ovum    within    the    ovary. 

Ovum.  (1)  An  egg.  (2)  The  female  reproductive  cell  which,  after 
fertilization,  develops  into  a  new  member  of  the  same  species.  The 
human  ovum  is  a  round  cell,  about  1-120  of  an  inch  in  diameter.  It 
consists  of  protoplasm  (vitellus,  or  yolk)  enclosed  by  a  cell-wall, 
which  consists  of  two  layers,  an  inner  one  (zona  pellucida,  zona 
radiata)  and  an  outer,  thin  one  (vitelline  membrane).  There  is  a 
large  nucleus  (germinal  vesicle),  within  which  is  a  nucleolus 
(germinal   spot). 

P 

Packing.  (1)  The  act  of  filling  a  wound  or  cavity  with  gauze,  sponge, 
or  other  material.  (2)  The  substance  used  for  filling  a  cavity. 
(3)    Treatment   with    the   pack. 

Pain.  (1)  Distress  or  suffering.  (2)  A  rhythmic  contraction  of  the 
uterus  in  labor.  After-Ps.,  the  expulsive  contractions  of  the  uterus 
which  follow  childbirth.  Bearing-down  P.,  a  variety  of  pain  in  the 
female  reproductive  organs  occurring  in  various  local  diseases  or  in 
childbirth.  Dilating-Ps.,  those  of  the  first  stage  of  labor.  Expul- 
sive Ps.,  those  of  the  second  and  final  stages  of  labor.  False  Ps., 
ineffective  pains  which  resemble  labor-pains,  but  which  do  not 
indicate  the  beginning  of  real  labor;  they  usually  occur  about  the 
eighth  month  of  gestation.  Premonitory  Ps.,  ineffective  uterine  con- 
tractions before  the  beginning  of  true  labor. 

Palpation  (pal-pa '  shun).  The  act  of  feeling  with  the  hand;  the  appli- 
cation of  the  fingers  with  light  pressure  to  the  surface  of  the  body 
for  the  purpose  of  determining  the  cons;stence  of  the  parts  beneath 
in   physical    diagnosis.      Bimanual   P.,    examination    with    both    hands. 

Palsy  (pawl'ze).  See  Paralysis.  Bell's  P.,  facial  paralysis.  Birth-P., 
palsy   due   to    injury    received    at   birth. 

Paracyesis    (par"ah-si-e'sis).      Extra-uterine   pregnancy. 


Glossary  227 


Paramastitis  (par"ah-mas-ti'tis).  Inflammation  of  the  tissues  around 
the  mammary  gland. 

Parenchyma  (par-en 'kim-ah).  The  essential  or  functional  elements  of 
an   organ   as   distinguished   from  its   stroma,    or   framework. 

Pareunia    (par-u'ne-ah).      Coitus;    sexual   intercourse. 

Parthenogenesis  (par"then-o-,ien'es-is).  Asexual,  or  virginal  reproduc- 
tion. 

Parturient  (par-tu're-ent).  (1)  Giving  hirth.  (2)  Pertaining  to  child- 
birth. 

Parturifacient  (par"tu-re-fa'shent).  (1)  Inducing  or  facilitating  child- 
birth.     (2)    A  medicine   that   induces   or   facilitates   childbirth. 

Parturiometer  (par"tu-re-om'et-er).  A  device  used  in  measuring  the 
expulsive  power  of  the  uterus. 

Parturition  (par-tu-rish'un).  The  act  or  process  of  giving  birth  to  a 
child. 

Pasteurization  (pas"tur-iz-a'shun).  The  arrest  or  checking  of  fermenta- 
tion by  heating  to   170°    F. 

Pasteurizer  (pas'tu-ri-zer).  An  instrument  used  in  effecting  pasteuri- 
zation. 

Pediatrics  (pe-de-at'riks) .  That  branch  of  medicine  which  treats  of 
the   diseases   of   children   and   their  treatment. 

Pelvimeter  (pel-vim'e-ter).  An  instrument  for  measuring  the  diameters 
and  capacity   of  the  pelvis. 

Pelvimetry  (pel-vim' et-re).  The  measurement  of  the  dimensions  and 
capacity  of  the  pelvis.  Combined  P.,  pelvimetry  in  which  measure- 
ments are  made  both  within  and  outside  the  body.  Digital  P., 
pelvimetry  performed  with  the  hands.  Instrumental  P.,  measure- 
ment of  the  pelvis  with  the  pelvimeter.  Internal  P.,  that  in  which 
the  measurements  are  made  within  the  vagina.  Manual  P.,  that 
which  is  performed  with  the  hands. 

Pelvis.  (1)  Any  basin-like  structure,  as  the  sac  in  the  kidney  of  which 
the  ureter  is  the  outlet.  (2)  The  basin-shaped  ring  of  bone  at  the 
posterior  extremity  of  the  trunk,  supporting  the  spinal  column  and 
resting  upon  the  lower  extremities.  It  is  composed  of  the  two 
innominate  bones  at  the  sides  and  in  front,  and  the  sacrum  and 
coccyx  behind.  It  is  divided  by  the  ilio-pectineal  line  into  the 
false  pelvis  above  and  the  true  pelvis  below.  The  upper  extrem- 
ity of  the  pelvic  canal  is  known  as  the  inlet,  brim,  or  superior  strait 
of  the  pelvis.  The  true  pelvis  is  limited  below  by  the  inferior 
strait  or  outlet,  formed  by  the  coccyx,  the  symphysis  pubis,  and 
the  ischium  of  either  side.  The  outlet  of  the  pelvis  is  closed  by 
the  coccygeus,  levator  ani,  and  perineal  fascia,  which  form  the 
floor  of  the  pelvis.  The  inlet  and  outlet  of  the  pelvis  have  each 
three  diameters — an  anteroposterior,  a  conjugate,  and  an  oblique. 
Brim  of  the  P.,  the  upper  entrance  to  the  intrapelvic  space;  the 
inlet,  isthmus,  margin,  or  superior  strait.  False  P.,  the  part  above 
the  ilio-pectineal  line.  Planes  of  the  P.,  two  imaginary  surfaces 
which  touch  all  points  of  the  pelvic  circumference,  caled  respec- 
tively the  plane  of  pelvic  expansion  and  plane  of  pelvic  contraction. 
True  P.,  the  part  below  the  ilio-pectineal  line. 

Perineum  (per-e-ne'um).  The  space  or  area  between  the  anus  and  the 
genital    organs. 

Peristalsis  (per-is-tal'sis).  The  worm-like  movement  by  which  the  ali- 
mentary canal  propels  its  contents.  It  consists  of  a  wave  of  con- 
traction passing  along  the  tube. 

Peritoneum  (per"it-o-ne'um).  The  serous  membrane  which  lines  the 
abdominal  walls  (Parietal  P.)  and  invests  the  contained  viscera. 
It  is  a  strong,  colorless  membrane  with  a  smooth  surface,  and  forms 
a  closed  sac  except  in  the  female,  in  whom  it  is  continuous  with  the 
mucous  membrane  of  the  Fallopian  tubes. 


228  Glossary 

Peritonitis  (per"it-o-ni'tis).  Inflammation  of  the  peritoneum;  a  con- 
dition marked  by  exudations  in  the  peritoneum  of  serum,  fibrin  and 
cells,   and  pus. 

Pessary  (pes'ser-e).  An  instrument  placed  in  the  vagina  to  support 
the  uterus   or  rectum. 

Phlebitis    (fle-bi'tis).     Inflammation  of  a  vein.  ^ 

Phlegmasia  (fleg-ma'zhe-ah).  Inflammation  or  fever.  P.  Al'ba  Do  lens, 
P.  Do 'lens,  phlebitis  of  the  femoral  vein  occasionally  following 
parturition  and  typhoid  fever.  It  is  characterized  by  swelling  of 
the  leg,  usually  without  redness.  Called  also  Leucophlegmasia,  Milk- 
leg,    and   White    Leg. 

Phygogalactic  (fi"go-gal-ak'tik).  Checking  the  secretion  of  milk; 
galactophygous. 

Pica  (pi'kah).  A  craving  for  unnatural  articles  of  food;  a  depraved 
appetite.      It   is   seen  in  hysteria  and  chlorosis  and   in  pregnancy. 

Placenta  (pla-sen'tah).  (1)  Any  cakelike  mass.  (2)  The  round, 
flat  organ  within  the  uterus  which  establishes  communication  between 
the  mother  and  child  by  means  of  the  umbilical  cord.  The  placenta 
is  a  circular  mass  about  seven  inches  in  diameter,  about  one  inch 
in  thickness,  and  weighing  about  sixteen  ounces.  It  consists  of  an 
interior  or  fetal  portion,  which  is  a  smooth,  shining  membrane  con- 
tinuous with  the  sheath  of  the  cord  (amnion),  the  cord  being  attached 
to  this  side,  and  an  external  or  maternal  portion,  which  is  of  a  dark 
red  hue,  divided  by  deep  sulci  into  lobes  of  irregular  outline  and 
extent  (the  cotyledons),  which  project  into  depressions  in  the  mucous 
membrane  of  the  uterus.  Adherent  P.,  one  which  adheres  abnormally 
to  the  uterine  wall  after  childbirth.  Annular  P.,  one  which  extends 
around  the  interior  of  the  uterus  like  a  ring  or  belt.  Battledore  P., 
one  with  a  marginal  attachment  of  the  cord.  Bilobed  P.,  Duplex  P., 
one  made  up  of  two  parts  or  lobes.  P.  Circumvalla'ta,  a  cup-shaped 
placenta.  Cirsoid  P.,  one  the  vessels  of  which  appear  to  be  varicose. 
Duplex  P.,  one  made  up  of  two  parts  or  lobes.  P.  Fenestra 'ta,  one 
which  has  spots  where  the  placental  tissue  is  lacking.  Fetal  P.,  that 
part  of  the  placenta  which  comes  next  to  the  fetus.  Fundal  P.,  one 
which  is  attached  to  the  fundus  in  the  normal  manner.  Horseshoe  P., 
a  crescentic  form  of  placenta  sometimes  occurring  in  twin  pregnancy. 
Incarcerated  P.,  a  placenta  retained  by  irregular  uterine  contractions. 
P.  Margina'ta,  a  placenta  which  is  surrounded  by  an  unusual  margin 
of  elevated  placental  tissue.  Maternal  P.,  that  part  of  the  placenta 
which  comes  next  to  the  uterine  wall :  rarely  adherent  when  the  rest 
of  the  placenta  is  expelled.  P.  Membrana'cea,  an  abnormally  thin 
form  of  placenta.  P.  Pre 'via,  a  placenta  which  is  attached  below  the 
dilating  zone  of  the  uterus.  It  may  lead  to  fatal  hemorrhage.  Re- 
tained P.,  a  placenta  usually  either  adherent  or  incarcerated  by 
irregular  uterine  contractions,  and  which  in  consequence  fails  to  be 
expelled  after  childbirth.  P.  Spu'ria,  a  placental  exclave  which  does 
not  take  part  in  the  nourishment  of  the  fetus.  Stone  P.,  a  placenta 
which  contains  calcareous  or  sabulous  deposits  of  greater  or  less 
extent.  Succenturiate  P.,  an  accessory  or  subsidiary  placenta  con- 
nected to  the  main  placenta  by  the  vessels.  P.  Triparti'ta,  a  triple 
or  triply  divided  placenta.  Velamentous  P.,  one  in  which  the 
umbilical  cord  is  attached  by  the  vessels  separately. 
Placental  (pla-sen'tal).  Pertaining  to  the  placenta. 
Placentation  (plas-en-ta'shun).     The  manner  of  formation  and  attachment 

of  the  placenta. 
Placentitis   (plas-en-ti'tis).     Inflammation  of  the  placenta. 
Pluripara    (plu-rip'ah-rah).      A    woman    who   lias   borne   several    children. 


Glossary  229 

Pluriparity     (plu-rip-ar'it-e).      The    fact     or    condition    of    having    borne 

several    children.  _ 

Position.  (1)  The  attitude  or  posture  of  a  patient.  (2)  The  relation 
certain  fixed  points  on  the  presenting  part  bear  to  fixed  points  on 
the  mother's  pelvis.  The  former  are  the  vertex,  mentum,  and  sacrum, 
the  latter  the  ends  of  the  oblique  diameters.  First  P.,  in  vertex 
presentation,  the  occiput  pointing  in  the  left  foramen  ovale.  Called 
also  left  occipito-cotyloid  position.  Fourth  P.,  the  occiput  pointing 
in  the  left  sacro-iliac  synchondrosis.  Called  also  left  occipito-sacro- 
iliac  position.  Genupectoral  P.,  Knee-chest  P.,  the  patient  resting 
on  her  knees  and  chest,  the  arms  crossed  above  the  head.  Lithotomy 
P.,  the  patient  on  the  back,  legs  flexed  on  the  thighs,  thighs  flexed 
on  the  belly,  and  abducted.  Called  also  dorsosacral  position. 
Second  P.,  the  occiput  pointing  in  the  right  foramen  ovale.  Called 
also  right  occipito-cotyloid  position.  Sims'  P.,  patient  on  the  left 
side  and  the  chest,  the  right  knee  and  thigh  drawn  up,  the  left  arm 
along  the  back.  Called  also  semiprone  position.  Third  P.,  in  vertex 
presentation,  that  in  which  the  occiput  presents  at  the  right  sacroiliac- 
synchondrosis.  Called  also  right  sacroiliac  position.  Trendelen- 
burg's P.,  the  patient  on  the  back  on  a  plane  inclined  45°,  the  legs 
and  feet  hanging  over  the  end  of  the  table.  Walcher's  P.,  the  patient 
on  the  back,  with  the  hips  at  the  edge  of  the  table  and  the  legs 
hanging  down. 
Postpartum  (post-par'tum).  Occurring  after  delivery,  or  childbirth. 
Postural  (pos'tu-ral).  Pertaining  to  posture,  or  position. 
Posture.     Attitude  or  position.      See  under  Position. 

Postuterine  (post-u'ter-in).  Situated  or  occurring  behind  the  uterus. 
Pregnancy.  The  condition  of  being  with  child;  gestation.  In  woman  the 
duration  of  pregnancy  is  about  280  days,  nine  calendar  or  ten  lunar 
months.  Abdominal  P.,  lodgment  of  the  ovum  within  the  abdominal 
cavity.  Broad  Ligament  P.,  pregnancy  taking  place  within  the 
broad  ligament.  Cervical  P.,  the  development  of  the  ovum  within  the 
cervical  canal.  Cornual  P.,  pregnancy  in  one  of  the  horns  of  a 
bicornute  uterus.  Ectopic  P.,  same  as  Extra-uterine  Pregnancy. 
Entopic  P.,  normal  uterine  pregnancy.  Extra-uterine  P.,  development 
of  the  ovum  outside  of  the  walls  of  the  uterus.  Fallopian  P.,  same 
as  Tubal  Pregnancy.  False  P.,  apparent,  but  not  real,  pregnancy. 
Interstitial  P.,  gestation  in  that  part  of  the  oviduct  which  is  within 
the  wall  of  the  uterus.  Mesometric  P.,  a  kind  of  tubal  pregnancy  in 
which  the  tube  has  ruptured  and  the  embryo  occupies  a  sac  formed 
partly  by  the  expanded  tube  and  partly  by  the  layers  of  the  perito- 
neum forming  the  mesometrium.  Molar  P.,  conversion  of  the  ovum 
into  a  mole.  Multiple  P.,  the  presence  of  more  than  one  ovum  in 
the  uterus  at  the  same  time.  Ovarian  P.,  pregnancy  occurring  within 
an  ovary.  Phantom  P.,  an  abdominal  enlargement  in  hysterical 
women  simulating  pregnancy.  Plural  P.,  pregnancy  with  more  than 
one  fetus.  Twin  P.,  gestation  with  twins.  Unconscious  P.,  pregnancy 
of  which  the  woman  is  unaware.  Utero-abdominal  P.,  pregnancy 
with  one  fetus  in  the  uterus  and  another  in  the  ovary.  Utero-tubal 
P.,  gestation  partly  within  the  uterus  and  partly  in  an  oviduct. 
Pregnant.     With   child;   gravid. 

Prenatal    (pre-na'tal).      Existing  or  occurring  before  birth. 
Prepotency    (pre-po'ten-cy).      Power  superior  to  that   of  the   other  parent 

in   transmitting  inheritable   characters   to   the   offspring. 
Prepotent    Cpre-po'tent).      Having    superior   force;    having   greater    power 
than    the    other   parent    in    transmitting   inheritable    characters    to    the 
offspring. 


230  Glossary 

Prepuce  (pre'pus).  The  fold  of  skin  covering  the  glans  penis;  the 
foreskin.  P.  of  the  Clitoris,  a  fold  formed  by  the  labia  minora 
covering  the   clitoris. 

Preputial    (pre-pu'shal).     Pertaining  to  the  prepuce. 

Presentation.  (1)  The  appearance  in  labor  of  some  particular  part  of 
the  fetal  body  at  the  os  uteri.  (2)  That  part  of  the  fetal  body 
which  first  shows  itself  at  the  os  in  labor.  Arm  P.,  prolapse  of  the 
arms  of  the  fetus;  generally  seen  in  shoulder-presentation.  Breast  P., 
the  presentation  of  the  anterior  part  of  the  chest  in  labor.  Breech 
P.,  the  presentation  of  the  fetal  buttock  in  labor.  Brow  P.,  the 
presentation  of  the  brow  in  labor.  Cephalic  P.,  the  presentation  of 
any  part  of  the  head,  including  the  vertex-presentation  and  face- 
presentation.  Face  P.,  the  presentation  of  the  face  of  the  fetus  in 
childbirth.  Foot  P.,  Footling  P.,  the  presentation  of  the  feet  in 
labor.  Funis  P.,  the  presentation  of  the  umbilical  cord  in  labor. 
Head  P.,  the  presentation  of  some  part  of  the  fetal  head  in  labor. 
Longitudinal  P.,  Polar  P.,  the  presentation  of  either  the  cephalic  or 
the  pelvic  end  of  the  fetal  ellipse.  Pelvic  P.,  presentation  of  the 
lower  end  of  the  fetus,  including  breech  presentation  and  foot 
presentation.  Placental  P.,  same  as  Placenta  Previa.  Transverse  P., 
Trunk  P.,  presentation  in  which  the  axis  of  the  fetal  trunk  lies 
crosswise  or  transversely;  cross-birth.  Vertex  P.,  the  presentation 
of  the  upper  and  back  part  of  the  fetal  head  in  labor. 

Primigravida  (prlm-ig-rav'id-ah).  A  woman  who  is  pregnant  for  the  first 
time. 

Primipara  (pri-mip'ar-rah).  A  woman  who  has  given  birth,  or  is  giving 
birth,  to  her  first  child. 

Primiparity  (pri-mip-ar'it-e).     The  condition  or  fact  of  being  a  primipara. 

Primiparous    (pri-mip'ar-us).     Bearing,  or  having  borne,  but  one  child. 

Privates.      The   external   genitalia. 

Prochorion  (pro-ko're-on).  (1)  The  thin  zona  pellucida  of  the  fertilized 
ovum  when  it  reaches  the  uterus.  (2)  The  coating  of  albuminous 
matter  which  the  ovum  receives  as  it  passes  along  the  oviduct. 

Procidentia   (pro-sid-en'she-ah).     A  prolapse,  or  falling  clown. 

Procreation    (pro-kre-a'shun).     The  act  of  begetting. 

Prognosis  (prog-no 'sis).  A  forecast  as  to  the  probable  result  of  an 
attack  of  disease;  the  prospect  as  to  recovery  from  a  disease  afforded 
by  the  nature  and  symptoms  of  the  case. 

Prolapse  (pro'laps).  The  falling  down,  or  sinking,  of  a  part  or  viscus; 
procidentia.  P.  of  the  Cord,  premature  expulsion  of  the  umbilical 
cord  in  labor. 

Prolific.     Fruitful ;  productive. 

Proligerous    (pro-lij 'er-us).      Producing  an   ovum. 

Promontory.  A  projecting  eminence  or  process.  P.  of  the  Sacrum,  the 
upper    and   projecting   part    of    the    sacrum. 

Pronucleus  (pro-nu'kle-us).  The  nucleus  of  the  egg-element  (female  p.) 
or  of  the  sperm-element  (male  p.)  after  the  coalition  of  the  sper- 
matozoon  with  the  ovum. 

Proto-.      A  prefix   signifying  first. 

Protoblast  (pro'to-blast).  (1)  A  cell  with  no  cell-wall.  (2)  The 
nucleus  of  an   ovum. 

Protuberance.      A    projecting   part;    an    apaphysis,    process,    or   swelling. 

Pruritus  (pru-ri'tus).  An  itching.  It  is  a  symptom  of  various  skin- 
diseases,    and    may    oecur    idiopathieally    as    a    neurosis. 

Pseudocyesis    (su"do-si-e'sis).      Spurious   or  false  pregnancy. 

Puberal   (pu'bcr-al).     Pertaining  to  puberty. 


Glossary  231 

Puberty.  The  age  at  which  the  reproductive  organs  become  functionally 
operative.  It  occurs  between  twelve  and  seventeen  years  of  age, 
and  is  indicated  in  the  male  by  change  of  voice  and  seminal  dis- 
charge, and  in  the  female  by  the   occurrence   of  menstruation. 

Pubes  (pu'bez).  (1)  The  hair  on  the  external  genitalia,  or  the  region 
covered  by  it.      (2)    The  pubic  bone. 

Pubescence    (pu-bes'ens).      (1)    Puberty.      (2)    Downiness;    lanugo. 

Pubescent  (pu-bes'ent).  (1)  Covered  with  down  or  lanugo.  (2)  Arriv- 
ing at  the   age  of  puberty. 

Pubetrotomy  (pu-be-trof  o-me) .  Section  of  the  os  pubis  and  of  the  lower 
abdominal  wall. 

Pubic    (pu'bik).      Pertaining   to   the  pubes,    or   os  pubis. 

Pubiotomy  (pu-be-of  o-me) .  The  operation  of  cutting  through  the  pubic 
bone,  lateral  to  the  median  line. 

Pubis    (pu'bis).      The  pubic  bone;   os  pubis,  or  pubes. 

Pudenda    (pu-den'dah) .      The   external   genital    organs. 

Pudendal    (pu-den'dal).      Pertaining  to  the  pudenda. 

Pudendum  (pu-den'dum) .  The  external  genital  parts,  especially  of  the 
female.     P.  Milieb're,  the  vulva. 

Pudic    (pu'dik).     Pertaining  to  the  pudenda. 

Puericulture    (pu-er'ik-ult-ur) .     The  art  of  rearing  and  training  children. 

Puerile    (pu'er-il).      Pertaining   to   childhood   or   to   children. 

Puerperal    (pu-er'per-al).      Pertaining   to   childbirth. 

Puerperalism  (pu-er'.per-al-izm).  A  diseased  condition  incident  to  child- 
birth. 

Puerperant    (pu-er'per-ant) .     A  puerperal  woman. 

Puerperium  (pu-er-per're-um) .  The  period  or  state  of  confinement; 
childbed. 

Purgation  (pur-ga'shun).  Catharsis;  purging  effected  by  a  cathartic 
medicine. 

Purgative  (pur'ga-tiv).  (1)  Cathartic;  causing  evacuations  from  the 
bowels.      (2)    A   cathartic   medicine. 

Pyelitis  (pi-el-i'tis).  Inflammation  of  the  pelvis  of  the  kidney.  It  may 
be  due  to  renal  calculus,  to  migration  of  the  colon  bacilli  direct 
from  the  bowel,  or  as  an  extension  of  inflammation  from  the  bladder. 
It  is  attended  by  pain  and  tenderness  in  the  loins,  irritability  of  the 
bladder,  chills,  remittent  fever,  bloody  or  purulent  urine,  sweats, 
diarrhea,  vomiting,   and  a  peculiar  pain  on  flexion  of  the  thigh. 

Pyelocystitis  (pi"el-o-sis-ti'tis).  Inflammation  of  the  renal  pelvis  and 
of  the  bladder. 

Pyemia,  Pyaemia  (pi-e'me-ah).  Blood-poison  of  microbic  origin;  septic 
infection   due   to   the    absorption   of  pyogenic   germs. 

Pyuria    (pi-u're-ah) .      The   presence    of   pus    in   the   urine. 


Quadrant  (kwod'rant).  (1)  One-quarter  of  a  circle;  that  portion  of 
the  circumference  of  a  circle  that  subtends  an  angle  of  90°.  (2)  Any 
one  of  four  corresponding  parts  or  quarters,  as  of  the  abdominal 
surface. 

Quadripara   (kwod-rip'ah-rah).     A  woman  who  has  borne  four  children. 

Quadriparity  (kwod-rip-ar'it-e).  The  condition  of  having  borne  four 
children. 

Quadriparous    (kwod-rip'ar-us).      Having  borne   four   children. 

Quadruplet    (kwod'ru-plet) .     Any  one  of  four  children  born  at  one  birth. 


282  Glossary 


Rectal    (rek'tal).      Pertaining  to  the  rectum. 

Rectum     (rek'tum).      The    lower,    or    distal,    part    of    the    large    intestine. 

extending    from    the    sigmoid   flexure    of   the    colon    (opposite    the   left 

sacro-iliac    symphysis)    to    the    anus,    being   from   six    to    eight    inches 

long.      Its  mucous  membrane   is  gathered   into  transverse  folds,    which 

serve   to   support   the   feces. 
Recumbent.      Lying  down. 

Reproduction.      The   production    of   offspring  by   organized  bodies. 
Reproductive.      Subserving    or   pertaining    to    the   production    of    offspring. 
Residual.      Remaining   or   left  behind. 
Retractor     (re-trak' tor).      An    instrument    for    drawing    back    the     edges 

of  a  wound. 
Retrocervical     (re-tro-ser' vik-al).      Behind    the    cervix    uteri. 
Retrodisplacement    (re"tro-dis-plas'ment).      A   backward   displacement. 
Retroesophageal   (re"tro-es-of-a'je-al).       Situated  or  occurring  behind  the 

esophagus. 
Retrofiexed    (re'tro-flext).      Bent    backward;    in    a    state    of    retroflexion. 
Retroflexion     (re-tro-flex'shun) .      The    bending    of    an    organ    so    that    its 

top   is   thrust   back 
Retromammary     (re-tro-mam '  ma-re).      Situated    or    occurring    behind    the 

mammary  gland. 
Retroperitoneal  (re"tro-per-it-o-ne'al).  Situated  behind  the  peritoneum. 
Retro-uterine  (re-tro  u'ter-in) .  Situated  or  occurring  behind  the  uterus. 
Retroversion  (re-tro-ver'shun).  The  tipping  of  an  entire  organ  backward. 
Retroverted  (re-tro-ver'ted).  In  a  condition  of  retroversion. 
R.  M.  A.  An  abbreviation  for  right  mento-anterior  position  of  the  fetus. 
R.  M.  P.  An  abbreviation  for  right  mento-posterior  position  of  the  fetus. 
R.  O.  A.  An  abbreviation  for  right  occipito-anterior  position  of  the  fetus. 
R.  0.  P.  An  abbreviation  for  right  occipito-posterior  position  of  the  fetus. 
R.  S.  A.  An  abbreviation  for  right  sacro-anterior  position  of  the  fetus. 
R.   S.  P.      An  abbreviation  for  right   sacro-posterior  position   of  the   fetus. 


Sac.  Any  bag-like  organ.  Amniotic  S.,  the  bag  of  waters.  Embryonic 
S.,  the  blastodermic  vesicle.  Gestation  S.,  the  sac  that  encloses  the 
embryo  in  ectopic  pregnancy.      Yolk   S.,   the   umbilical   vesicle. 

Saccharomyces  (sak-kar-om'is-sez).  A  genus  of  protophytes;  the  yeast- 
fungi.  The  organisms  consist  of  oval  or  spheric  cells,  single  or  in 
chains,  sometimes  forming  a  mycelium  of  filaments,  and  increasing 
by  spores  or  buds.  S.  Al'bicans,  a  pathogenic  species  causing  a 
thrush  in  the  mouth;  in  white,  oval,  spherical,  or  cylindrical  cells, 
sometimes   forming   long   filaments. 

Sacro-uterine   (sa-kro-u'  ter-in).      Pertaining  to  the  sacrum  and  the  uterus. 

Sacro-vertebral  (sa-kro-ver '  te-bral).  Pertaining  to  the  sacrum  and  the 
vertebra. 

Sacrum  (sa'krum).  The  triangular  bone  situated  dorsad  and  caudacl 
from  the  two  ilia.  It  is  formed  of  five  united  vertebra?  wedged 
in    between    the    two    innominate   bones. 

Secundines  (se-kun'dinz).  The  after-birth;  the  placenta  and  membranes 
expelled    after   childbirth. 

Secundipara   (se-kun-dip'ah-rah).      A   woman  who  has  borne  two  children. 

Secundiparity   (se-kun-dip-ar 'it-e).      The  condition  of  being  a  secundipara. 

Secundiparous     (se-kun-dip'ah-rus).      Having    borne    a    second    child. 

Segmentation  (seg-men-ta'shun).  Division  into  parts  more  or  less  simi- 
lar, especially  that  which  takes  place  in  the  fertilized  ovum.  S. 
Nucleus,   the   result   of  t lie   fusion   of  the   male   and    female  pronucleus. 


Glossary  233 


Semen  (se'men).  (1)  Any  seed  or  seed-like  fruit.  (2)  The  thick, 
whitish,  liquid,  fecundating  secretion  produced  by  the  testes  and 
ejaculated  in  coition.  It  is  composed  of  liquor  seminis  (a  clear, 
limpid  fluid),  holding  in  suspension  the  spermatozoa,  seminal  and 
other    granules,    epithelial    cells,    and    oil-globules. 

Seminal    (sem'in-al).      Pertaining   to   seed   or   to   the    semen. 

Semination  (sem-in-a'shun) .  The  introduction  of  semen  into  the  vagina 
or  uterus. 

Seminiferous    (sem-in-if  er-us).      Producing  or  conveying  semen. 

Septic    (sep'tik).      Produced  by   or   due   to   putrefaction. 

Septicemia,  Septicaemia  (sep-tis-e'me-ah).  A  morbid  condition  due  to  the 
presence  of  non-specific  pathogenic  bacteria  and  their  associated 
poisons     (toxins    and    toxalbumins)     in    the    blood. 

Serotina    (se-rot'in-ah).      Same    as   Decidua    Serotina. 

Sex.      The    distinctive   generative    character. 

Sexology    (sex-ol'o-je).      The   doctrine    of    the    sexes    and   their   relations. 

Sextigravida    (sex-tig-rav'id-ah).      A   woman  pregnant  for   the   sixth   time. 

Sextipara    (sex-tip'  ar-rah) .      A   woman    who    has   borne    six    children. 

Sexual.      Pertaining  to   sex. 

Sexuality  (sex-u-al'it-e).  The  characteristic  quality  of  the  male  and 
female  reproductive  elements. 

Sincipital   ( sin-sip '  it-al) .      Pertaining  to  the  sinciput. 

Sinciput   (sin'sip-ut) .      The  anterior  and  upper  part  of  the  head. 

Smegma  (smeg'mah).  A  thick,  cheesy,  ill-smelling  secretion  found  under 
the  prepuce  and  around  the  labia  minora.  Called  also  Smegma 
Prceputii.      S.  Embryo 'num,  the  vernix  caseosa. 

Somatopleure  (so-mat'o-plur).  (1)  The  somatic  mesoblast ;  the  upper 
layer  of  the  mesoblast  adjoining  the  epiblast,  the  under  one  being 
the  splanchnopleure.  (2)  More  correctly,  the  layer  formed  by  the 
somatic  mesoblast  and  the  epiblast. 

Souffle  (soof'fl).  A  soft,  blowing,  auscultatory  sound.  Fetal  S.,  a  blow- 
ing sound  sometimes  heard  in  pregnancy,  supposed  to  be  due  to  com- 
pression of  the  umbilical  vessels.  Funic  S.,  Funicular  S.,  a  hissing 
souffle  synchronous  with  the  fetal  heart-sounds,  and  supposed  to  be 
produced  in  the  umbilical  cord.  Placental  S.,  a  souffle  suppos?.d  to 
be  produced  by  the  blood-current  in  the  placenta.  Umbilical  S., 
same  as  Funicular  S.  Uterine  S.,  a  sound  made  by  the  blood  within 
the    arteries    of    the    gravid    uterus. 

Sperm.  The  semen,  or  testicular  secretion.  S.  Cell,  a  spermatozoon; 
more  correctly,  a  spermatid.  S.  Nucleus,  the  nucleus  of  a  spermato- 
zoon ;  more  especially  after  it  has  entered  the  egg  and  before  its 
union   with  the   nucleus   of  the    ovum. 

Spermatic    (sper-mat'ik).      Pertaining   to   the   semen;    seminal. 

Spermatid  (sper' mat-id).  A  cell  derived  from  a  secondary  spermatocyte 
by  fission  and  developing  into  a  spermatozoon.  Called  also  Spermato- 
blast. 

Spermatin  (sper  'mat-in) .  An  albuminoid  substance  derived  from  semen. 
It   is   related   to   mucin   and   to  alkali-albumen. 

Spermatism    (sper'mat-izm).      The  production  or  discharge   of  semen. 

Spermatogenesis  (sper"mat-o-jen'es-is).  The  development  of  the  sper- 
matozoon. 

Spermatogenic   (sper"mat-o-jen'ik).     Producing  semen,  or  spermatozoa. 

Spermatozoid    (sper'mat-o-zoid).      Same   as   Spermatozoon. 

Spermatozoon  (sper"mat-o-zo' on).  The  motile  generative  element  of  the 
semen  which  serves  to  impregnate  the  ovum.  It  consists  of  a  head, 
or  nucleus,  a  middle  piece,   and  a  flagellum.   or  tail. 


234  Glossary 

Splanchnopleure  (splank'no-plur).  (1)  The  inner  layer  of  the  mesoblast, 
separated  from  the  somatopleure  by  the  pleuroperitoneal  space. 
Called  also  Splanchnic  Mesoblast  and  Visceral  Mesoblast.  (2)  The 
layer  formed  by  the  union  of  the  splanchnopleure  (1st  def.)  with  the 
hypoblast.  From  it  are  developed  the  muscles  and  the  connective 
tissue   of  the  intestines. 

Spotting.     A  slight  menstrual  show  upon  a  woman's  napkin. 

Staphylococcus  (staf"il-o-kok'kus).  A  genus  or  form  of  bacteria  made  up 
of  cocci  aggregated  into  irregular  masses. 

Sterile.  (1)  Not  fertile;  infertile;  barren;  not  producing  young.  (2) 
Aseptic;  not  producing  microorganisms;   free  from  microorganisms. 

Sterility.     Barrenness;    inability  to  produce  young. 

Sterilization.  The  act  or  process  of  rendering  sterile ;  the  process  of 
freeing  from  all  germs.  It  is  usually  performed  by  means  of  heat. 
Sterilization  differs  from  disinfection  in  that  it  calls  for  the  destruc- 
tion of  all  bacterial  life,  while  disinfection  is  not  necessarily  the 
destruction  of  all  bacteria,  but  only  those  that  are  infectious. 

Stillbirth.     The  birth  of  a  dead  fetus. 

Strait.      Either  opening,   superior  or  inferior,   of  the  pelvis. 

Streptococcus  (strep-to-kok'kus) .  A  genus  or  form  of  bacterial  organisms 
made  up  of  cocci  arranged  in  wreath-like  shapes;  by  some  regarded 
as  a  sub-genus  of  micrococcus. 

Stria  (stri'ah).  A  streak  or  line.  S.  Gravida 'rum,  the  stria?  seen  upon 
the  abdomen  of  pregnant  women.  Striae  atrophicae,  same  as  Linea 
Albicantes. 

Striation  (stri-a'shun).  (1)  The  quality  of  being  streaked.  (2)  A 
streak  or  scratch ;  also  a  series  of  streaks  or  scratches. 

Sudamina  (su-dam'in-ah).  Whitish  vesicles  caused  by  the  retention  of 
sweat  in  the  sudorific  ducts  or  the  layers  of  the  epidermis.  The 
vesicles  are  about  the  size  of  millet-seeds,  and  the  eruption  occurs 
after  profuse  sweating,   or  in  certain  febrile  diseases. 

Superfecundation  (su"per-fe-kun-da'shun).  The  successive  fecundation  of 
two  ova   formed  at   the   same   menstrual  period. 

Superfetation  (su"per-fe-ta'shun) .  The  fertilization  in  the  same  uterus 
of  two  ova  formed  at  different  menstrual  periods;  the  fecundation  of 
a  woman  already  pregnant. 

Superimpregnation  (su"per-im-preg-na'shun).  (1)  Superfecundation. 
(2)    Superfetation. 

Superinvolution  (su"per-in-vo-lu'shun).  Hyperinvolution;  excessive  invo- 
lution by  which  the  uterus  after  childbirth  is  reduced  to  less  than 
its  normal  size. 

Suppression.  The  sudden  stoppage  of  a  secretion,  excretion,  or  normal 
discharge. 

Suppuration.  The  formation  of  pus ;  the  act  of  becoming  converted  into 
the   discharging  pus. 

Supravaginal   (su-prah-vaj '  in-al).     Situated  above  or  outside  of  a  sheath. 

Symphyseotomy,  Symphysiotomy  (sim-fiz-e-ot'o-me).  The  division  of  Ihe 
fibro-cartilage  of  the  symphysis  pubis,  in  order  to  facilitate  delivery 
by   increasing   the   antero-posterior   diameter   of   the   pelvis. 

Synciput    (sin'sip-ut).      Same  as   Sinciput. 

T 
Tampon  (tam'pon).     A  plug  made  of  cotton,  sponge,  or  oakum;  variously 

used    in   surgery   to   plug   the    nose,    vagina,    etc.,    for   the    control    of 

hemorrhage  or  the  absorption  of  secretions. 
Tamponade    (tampon-ad').     The   surgical  use   of  the  tampon. 
Tamponment   (tam-pon'ment).     The  act  of  plugging  with  a  tampon. 
Technique    (tek'nek).      The   method   of  procedure   and  the   details   of  any 

mechanical  process   or  surgical   operation. 


Glossary  235 


Teeth.  The  organs  of  mastication.  Deciduous  T.,  Milk  T.,  Temporary  T., 
the  teeth  of  the  first  dentition. 

Teething.     The  cutting  of  the  teeth;    dentition.      See  under  Tooth. 

Temperature.  The  degree  of  sensible  heat  or  cold.  Absolute  T.,  that 
which  is  reckoned  from  the  absolute  zero  of  —273°  C.  Body  T.,  the 
temperature  of  the  body.  T. -Curve,  a  curved  or  broken  line  exhibiting 
the  variations  of  the  bodily  temperature  in  a  given  period.  Normal 
T.,  that  of  the  human  body  in  health,  or  98.6°  F.  This  is  main- 
tained in  health  by  the  thermotaxic  nerve-mechanism,  which  keeps  a 
balance  between  the  thermogenetic,  or  heat-producing,  and  the  ther- 
molytic,    or  heat-dispelling,    processes. 

Ter   in   die    (ter   in    de'a).      Latin   for    "thrice    in   a    day.'' 

Testicle  (tes'tik-kl).  Either  one  of  the  two  glands  which  produce  semen. 
It  is  an  ovid  body,  suspended  in  the  scrotum  from  its  posterior  edge 
by  the  spermatic  cord. 

Testis   (tes'tis).     A  testicle. 

Tetanus  (tet'an-us).  An  acute  disease  due  to  the  Bacil'lus  Tet'ani,  in 
which  there  is  a  state  of  more  or  less  persistent  tonic  spasm  of  some 
of  the  voluntary  muscles. 

Tetany  (tet'an-e).  A  disease  characterized  by  painful  tonic  and  sym- 
metric spasm  of  the  muscles  of  the  extremities. 

Theca  (the'kah).  A  case  or  sheath,  as  of  a  tendon.  T.  Follic'uli,  the 
outer  covering  of  the  Graafian  follicle. 

Thelyblast  (thel'ib-last).  (1)  The  f eminonucleus ;  the  active  element  of 
the  female  generative  cell.  (2)  The  passive  element  of  the  male 
generative   cell. 

Thermometer.  An  instrument  for  ascertaining  temperatures.  It  consists 
of  a  substance  which  expands  and  contracts  with  alterations  of 
temperature ;  and  of  a  graduated  scale  indicating  the  degree  of  expan- 
sion or  contraction. 

Thrombophlebitis  (throm"bo-fle-bi'tis).  Thrombosis  conjoined  with  in- 
flammation of  a  vein  or  of  veins. 

Thrombosed    (throm'bSzed).      Affected  with  thrombosis. 

Thrombosis   (throb-bo '  sis ) .      The  formation  or  development  of  a  thrombus. 

Thrombus  (throm'bus).  A  plug  or  clot  in  a  vessel  remaining  at  the 
point  of  its  formation. 

Thrush.  (1)  Aphthous  stomatitis;  a  disease  of  infants  attended  with  the 
formation  of  aphthas,  or  whitish  spots  in  the  mouth.  It  is  due  to  the 
presence  of  a  fungus,  Saccharmyces  Al'bicans.  The  aphthae  are 
followed  by  shallow  ulcers. 

Thymus  (thi'mus).  A  two-lobed  body  in  the  neck  and  thorax  of  an  infant 
or  of  a  young  animal. 

T.  I.  D.     An  abbreviation  for  the  Latin  ter  in  die,   "three  times  a  day." 

Tooth.  Any  one  of  a  set  of  small  bone-like  structures  of  the  jaws*  for 
masticating  the  food.  There  are  two  sets  of  teeth,  the  Temporary 
(Milk  or  Deciduous)  T.,  which  are  lost  in  childhood,  and  the  Perma- 
nent T.,  which  begin  in  the  seventh  year  to  displace  the  temporary 
teeth  and  last  till  old  age.  There  are  20  temporary  teeth,  10  in 
each  jaw,  as  follows:  4  incisors,  2  canines,  and  4  molars.  There 
are  32  permanent  teeth,  16  in  each  jaw,  as  follows:  4  incisors,  2 
canines,  4  bicuspids,   and  6  molars. 

Toxin   (tox'in).     Any  poisonous  albumen  produced  by  bacterial  action. 

Traction.  The  act  of  drawing.  Axis  T.,  traction  along  an  axis,  as  of  the 
pelvis   in   obstetrics. 

Transfusion  (trans-fu'shun).  The  transfer  of  blood  from  one  person  to 
another;  the  introduction  of  blood  from  the  vessels  of  another  per- 
son; also  the  introduction  into  the  blood-vessels  of  any  substance,  as 
saline  solution. 


236  Glossary 


Triangle.      (1)  A  three-cornered  area  or  figure.      (2)  A  triangular  bandage. 
Tripara   (trip'ar-ah).     A  woman  who  has  borne  three  children. 
Turning.      Version   in  obstetric  practice. 
Turn  of  Life.     Same  as  Menopause. 

Twin.  One  of  two  individuals  born  at  the  same  birth.  T.  Labor,  tedious 
labor  due  to  the  presence  of  two  fetuses. 

U 

Umbilical    (um-bil'  ik-al) .      Pertaining  to  the  umbilicus. 

Umbilicus  (um-bil-i'kus).  The  navel;  the  cicatrix  which  marks  the  site 
of  the  entry  of  the  umbilical  cord. 

Urachus  (u'rak-us).  A  cord  which  extends  from  the  apex  of  the  bladder 
to  the  navel.  It  represents  the  remains  of  the  canal  in  the  fetus 
which  joins  the  bladder  with  the  allantois. 

Uremia,  Uraemia  (u-re'me-ah).  The  presence  of  urinary  constituents  in 
the  blood,  and  the  toxic  condition  produced  thereby.  It  is  marked 
by  nausea,  vomiting,  headache,  vertigo,  dimness  of  vision,  coma  or 
convulsions,  and  a  urinous  odor  of  the  breath  and  perspirations.  It 
is  due  to  suppression  or  deficient  secretion   of  urine   from   any   caus_> 

Uremic    (u-re'mik).      Caused  by  or  pertaining  to  uremia. 

Ureter  (u-re'ter).  The  fibro-muscular  tube  which  conveys  the  urine  from 
the  kidney  to  the  bladder.  It  begins  with  the  pelvis  of  the  kidney 
a  funnel-like  dilatation,  and  empties  into  the  base  of  the  bladder, 
being   from   sixteen   to   eighteen   inches   long. 

Ureteropyelitis  (u-re"ter-o-pi'el-i-tis).  Inflammation  of  a  ureter  and  of 
the   pelvis   of   a   kidney. 

Urethra  (u-re'thrah ).  A  membranous  canal  conveying  urine  from  the 
bladder  to  the  surface,  and  in  the  male  conveying  the  seminal  ejacu- 
lations. The  Female  Urethra  is  one  and  a  half  inches  long;  it  runs 
above  the  anterior  vaginal  wall  and  pierces  the  triangular  ligaments 
as  in  the  male.      Its  structure  is  similar  to  that  of  the  male  urethra. 

Urethral   (u-re'thral).      Pertaining  to  the  urethra. 

Urethritis    (u-re-thri' tis) .      Inflammation   of  the  urethra. 

Urethroscope  (u-re'thro-skop).  An  instrument  for  viewing  the  interior 
of  the  urethra. 

Urina    (u-ri'nah).      Latin   for  urine. 

Urinal    (u'rin-al).      A  vessel   or  other  receptacle   for  urine. 

Urinalysis   (u-rin-al' is-is).     The  chemical  analysis  of  urine. 

Urinary  (u'rin-a-re).  Pertaining  to  the  urine;  containing  or  secreting 
urine. 

Urinate    (u'rin-at).      To   void   or   discharge   urine. 

Urination  (u-rin-a'shun).  The  discharge  or  passage  of  the  urine;  mictu- 
rition. Stuttering  U.,  an  intermittent  flow  of  urine,  due  to  vesical 
spasms. 

Urine  (u'rin).  The  fluid  secreted  by  the  kidneys,  stored  in  the  bladder. 
and  discharged  by  the  urethra.  Urine,  in  health,  has  an  amber  color 
a  slight  acid  reaction,  a  peculiar  odor,  and  a  bitter,  saline  taste. 
The  average  quantity  secreted  in  24  hours  in  a  man  in  health  is 
about  3  pints,  or  from  1200-1600  c.c.  Specific  gravity  about  1.024 
varying  from  1.005-1.030.  One  thousand  parts  of  healthy  urine  con- 
tain about  960  parts  of  water  and  40  parts  of  solid  matter,  which 
consists  chiefly  of  urea.  23  parts;  sodium  chloride,  11  parts;  phos- 
phoric acid,  2.3  parts;  sulphuric  acid.  1.3  parts;  uric  acid.  0.5  part; 
also  hippuric  acid,  leukomains,  urobilin,  and  certain  organic  salts. 
The  abnormal  matters  found  in  the  urine  in  various  conditions  includ  • 
acetone,  albumen,  albumose,  bile,  blood,  cystin,  glucose,  hemoglobin. 
fat,   pus,   spermatozoa,   epithelial   cells,   mucous   casts,   etc. 


Glossary  237 


Urinometer  (u-rin-om'et-er) .  An  instrument  for  determining  the  specific 
gravity  of  the  urine. 

Uterogestation  (u"ter-o-jes-ta'shun).  (1)  Uterine  pregnancy;  any  preg- 
nancy which  is  not  extra-uterine.  (2)  The  full  period  or  time  of 
normal   pregnancy. 

Uteroplacental  (u"ter-o-plas-en'tal).  Pertaining  to  the  uterus  and  the 
placenta. 

Uterovaginal  (u"ter-o-vaj 'in-al).     Pertaining  to  the  uterus  and  the  vagina. 

U'terovesical  (u"ter-o-ves'ik-al).  Pertaining  to  the  uterus  and  the 
bladder. 

Uterus  (u'ter-us).  The  womb;  a  hollow  muscular  organ,  the  abode  and 
place  of  nourishment  of  the  embryo  and  fetus.  It  is  a  pear-shaped 
structure,  about  three  inches  in  length,  consisting  of  a  broad,  flatten- 
ed part  (body)  above  and  a  narrow,  cylindrical  part  (cervix)  below. 
Its  cavity  opens  into  the  vagina  below  and  into  the  Fallopian  tubes 
on  either  s;de  above.  It  is  held  in  place  by  a  broad  ligament,  a 
transverse  fold  of  peritoneum  which  encloses  it  on  either  side,  and 
by  various  ligaments,  such  as  the  round  ligaments,  the  recto-uterine 
ligaments,  and  the  vesico-uterine  ligaments.  It  is  made  up  of  a 
peritoneal  coat,  a  middle  layer  of  unstriated  muscular  fibers  (which 
constitutes  most  of  its  thickness),  and  a  mucous  coat,  which  con- 
tains numerous  mucous  follicles  or  uterine  (utricular)  glands,  and 
is  lined  by  ciliated  epithelium. 

V 

Vagina  (vaj-i'nah).  (1)  A  sheath.  (2)  The  canal,  from  the  slit  of  the 
vulva  to  the  cervix  uteri,  which  receives  the  penis  in  copulation.  In 
the  virgin  adult  it  is  two  to  two  and  a  half  inches  on  the  anterior 
wall,  three  to  three  and  a  half  inches  on  the  posterior  wall.  The 
anterior  and  posterior  walls  are  in  contact.  Its  upper  extremity  em- 
braces the  cervix  uteri,  the  posterior  wall  reaching  the  cervix  higher 
up  than  does  the  anterior  wall.  Anteriorly  and  posteriorly  there 
are  a  median  ridge  and  the  columnas  vagina?,  and  running  out  from 
the  columnaa  on  either  side  transverse  folds,  or  rugfe.  The  hymen 
is  a  crescentic  or  circular  mucous  fold  which  constricts  its  entrance. 
When  the  remains  of  the  hymen  are  stretched  in  childbirth,  warty 
eminences  mark  its  site,  the  carunculaa  myrtiformes.  The  vagina 
has  three  coats:  (1)  Outer,  or  fibro-elastic.  (2)  Middle,  or  muscu- 
lar. (3)  Mucous,  internal.  The  circular  muscular  fibers  near  the 
entrance    constitute    the    vaginal    sphincter. 

Vaginal  (vaj' in-al).  (1)  Of  the  nature  of  a  sheath;  ensheathing.  (2) 
Pertaining   to   the    vagina. 

Vaginismus  (vaj-in-iz'mus).  Painful  spasm  of  the  vagina,  due  to  local 
hyperesthesia. 

Vaginitis  (vaj -in-i 'tis).  (1)  Inflammation  of  the  vagina.  It  is  marked 
by  pain  and  by  a  purulent  leucorrheal  discharge.  (2)  Inflammation 
of  a  sheath. 

Velamentous  (vel-am-en'tus).  (1)  Membranous  and  pendent  like  a  veil. 
(2)  Insertion  of  the  umbilical  cord  in  the  placenta  by  means  of  its 
vessels. 

Venesection  (ven-e-sek'shun).  The  opening  of  a  vein  for  the  purpose  of 
letting   blood;    phlebotomy. 

Veratrum  (ver-a' trum) .  A  genus  of  poisonous  liliaceous  plants.  V. 
Vir'ide,  the  green  hellebore  of  North  America,  and  its  sedative  and 
depressant  rhizome  and  roots.  Dose  of  fluid  extract,  1-5  min. ;  of 
tincture,    1-5  min. 

Vertex  (Ver'tex).  The  summit  or  top;  the  crown  of  the  head.  V.  Pres- 
entation,   see    Presentation. 


238  Glossary 


Vesicle  (ves'ik-1).  (1)  A  small  bladder  or  sac  containing  liquid.  (2)  A 
small  blister;  a  small  circumscribed  elevation  of  the  epidermis,  con- 
taining a  serous  liquid.  Allantoic  V.,  the  internal  hollow  portion  of 
the  allantois.  Germinal  V.,  the  nucleus  of  an  ovum.  Graafian  V., 
the  structure  which  holds  the  ovum  while  still  within  the  ovary. 
Umbilical  V.,  that  part  of  the  yolk-sac  which  is  outside  the  body 
of  the  embryo,  being  joined  to  it  by  means  of  the  umbilical  or 
omphalomesenteric  duct. 

Vesicorectal  (ves"ik-orek'tal).     Pertaining  to  the  bladder  and  the  rectum. 

Virgin.     A  woman  or  girl  who  has  had  no  sexual  intercourse. 

Virginal   (vir' jin-al).      Pertaining  to  a  virgin  or  to  virginity. 

Virginity    (vir-jin'it-e).     Maidenhood;  the  condition  of  being  a  virgin. 

Vitelline  (vi-tel'lin).  Resembling  or  pertaining  to  the  yolk  of  an  egg 
or  ovum. 

Vitellus   (vi-tel'lus).     The  yolk  of  eggs  or  of  an  ovum. 

Viviparous  (vi-vip'ar-us).  Bringing  forth  young  alive;  producing  living 
young. 

Volsella    (vol-sel'lah).      A   forceps   with   hooked   blades. 

Vomiting.  The  forcible  expulsion  of  the  contents  of  the  stomach  through 
the  mouth.  Pernicious  V.,  vomiting  in  pregnancy,  so  severe  as  to 
threaten  the  life  of  the  patient. 

Vulsella    (vul-sel'lah).      Same    as    Volsella. 

Vulva  (vul'vah).  The  external  part  of  the  organs  of  generation  of  the 
female. 

Vulval,  Vulvar   (vul'val,  vul'var).     Pertaining  to  the  vulva. 

Vulvitis    (vul-vi' tis).      Inflammation   of  the   vulva. 

Vulvovaginal    (vul-vo-vaj'in-al).      Pertaining  to   the   vulva   and   vagina. 

Vulvovaginitis  (vul"vo-vaj-in-i'tis).  Inflammation  of  the  vulva  and 
vagina. 

W 

Wharton's  Jelly.     See  Jelly. 

Whey.  The  thin  serum  of  milk  remaining  after  the  curd  and  cream  have 
been  removed.  Wine  W.,  the  watery  part  of  milk  coagulated  with 
rennet  or  pepsin,  strained  from  the  curd,  to  which  wine  has  been 
added,   and   sweetened   with   sugar. 


Yelk.     The  yelk  of  an  egg,  or  ovum. 

Yoghurt  (yog'hert).  Bulgarian  clotted  milk;  said  to  expel  harmful 
intestinal    bacteria. 

Yolk.  (1)  The  nutrient  part  of  the  ovum;  also  the  yellow  portion  of  the 
egg  of  a  bird.  (2)  Crude  wool-fat,  or  suint.  Accessory  Y.,  the 
nutritive  yolk;  the  portion  of  the  yolk  that  serves  for  the  nutrition 
of  the  formative  portion.  Y.  Cells,  Y.  Granules,  the  morphologic 
elements  composing  the  yolk.  Y.  Cleavage,  segmentation  of  the 
vitellus.  Y.  Food,  the  nutritive  part  of  the  yolk  of  an  ovum;  deu- 
teroplasm.  Formative  Y.,  that  part  of  the  ovum  whence  the  embryo 
is  developed.  Y.  Sac,  same  as  umbilical  vesicle;  see  Vesicle. 
Y.  Skin,  the  vitelline  membrane  (q.  v.).  Y.  Space,  the  space  formed 
in  the  ovum  by  the  shrinking  of  the  vitellus  from  the  zona  pellucida. 
Y.   Stalk.     Same  as  umbilical  duct.      See  Duct. 

Z 

Zooblast    (zo'o-blast).      An   animal   cell. 


INDEX 


Abdomen,    enlargement    of    in    preg- 
nancy,   28. 
Striae   of,    30. 
Abdominal     binder,     77. 

Supporters,  37,   187. 
Abscess   of  breast,   178. 
Advice    to   expectant    mothers,    186 
Afterbirth,    18,    21,    22,    45. 
After-pains,  86,  88.  175. 
Amnion,    18,    19,    21. 
Amniotic     fluid,      21. 

Sac,  rupture   of,   46. 
Anesthesia,    147. 

Obstetrical     degree,      66. 
Surgical   degree,    66. 
Annealing   bottles.    136. 
Antiseptic    solutions,    table    of,    59, 

201. 
Anus,   imperforate,   in   newborn,   99, 

116,   117. 
Appendix,    197. 
Applicator,    funis    band.    67. 
Aphthae,    Bednars',    110. 
Areola,    primary,    27. 

Secondary,   27. 
Arnold    pasteurizing    bottles,    136. 
Artificial    feeding,    131. 
Foods,      139. 
Eespiration.     105. 

Byrd-Dew    method.     107. 
Laborde    method.    108. 
Schultze      method,      105,      106. 

107. 
Sylvester's    method.    105. 
Asphvxia  in  newborn,   103,   124. 
Atelectasis.   124.   127. 

Phvsical    signs   in,    124. 
.Utitude.    47. 

Auto-intoxication     from    bowel.     79, 
181. 

B 
62. 


Babv's    basket, 
Clothes.    60. 

Bacillus,     coli, 
177. 
And    pvelitis. 


and     cystitis,     176, 
177. 


Klebs-Loeffler.    in   milk.    139. 
Bacterial  standard  of  certified  milk, 

135. 
■Rallottement.     26. 
Balsam    of    Peru    in    treatment    of 

cord,    94.    95. 


Band  for  retaining  lochial  pads,   71. 
Barnes'    bags,    161. 
Bartholin,  glands  of,  8. 
Basins,   sterilization  of,   200. 
Basket,    baby's,     62. 
Bath    before    delivery,    54. 

Temperature  of,  for  newborn,  96. 

Tub.    collapsible,    97. 
Bathing   in  pregnancy,    41,    189. 

Of  newborn,    96. 
Battledore  insertion  cord,  23. 
Bed,    pi*eparation    of    for    deliverv. 
53. 

Preparation     of     for     operations. 
144. 
Bednars'   aphtha?,   110. 
Bedside    notes,    86,    87. 
Bier  suction  treatment   in  mastitis, 

179. 
Binder,    breast    and    abdominal,    76. 
77. 

Baby,     96. 

Pattern,   74. 
Bladder,     176. 

Catheterization    of,     81,    82. 

In    pregnancy,    44. 

In    puerperium,     81. 

Irritability    of,    29. 
Blastodermic  vesicle,   17. 
Blastula,    17. 
bleeders.    122. 

Blindness    from    ophthalmia    neona- 
torum,   92. 
Blood  poisoning,   174. 

In    pregnancy,    31. 
Boracic    acid    solution.    197. 
Bottle    annealing.    136. 

Arnold   pasteurizing,    136. 

Care    of    nursing.    13  6. 

Hvgeia    Nursing.    136. 

Whitehall-Tatum.    136. 
Bowel,    auto-intoxication    from.    79. 
181. 

Baby's,   97. 

First    discharge    from.    97. 

Care   of.   in  pregnancy,    38,    189. 
Tn    newborn.    97. 
In   puerperium,    80. 
Breast    milk,    examination    of.    130. 
Breasts  and  nipnles,   9.   11,   73. 

Binder,    76,    77. 
Pattern,    74. 

Cake  or  weed  in,  76. 

Changes  in,  in  pregnancy,   27. 


240 


Index 


Breasts  and  nipples — Continued. 

Inflammation  of,  178. 

In  newborn,    118. 

Pump,    English,     78. 
Suction,    78. 

Stria?     of,     28. 

Supernumerary.     10. 
Breech   presentation,    47,    153,    17'). 
Brim     of     pelvis,     4. 
Byrd-Dew   method    of   artificial    res- 
piration, 107. 


Cesarean    section,     7,     143,     154. 

Vaginal,    143. 
Cake  in  breast,  76. 
Caput    succedaneum,    118. 
Carbolic   acid  solution,    198,    201. 
Caruncula    myrtiformes,    9. 
Carus,    curve   of,    6,    89,    152. 
Cascara    sagrada,    38. 
Catheter,   glass,    83. 
Catheterization.    8,    81,    176. 
Caul,    46,    69. 
Cephalhematoma.     119. 
Cerebral  hemorrhage,   128. 
Cereo    Company,    133. 
Certified    milk,     135. 

Bottle    showing    cream    line,    133. 
Cervix,    12. 

Dilatation   of,    4  6. 
Chapin's   cream  dipper,   132. 

Modified   milk    table,    134. 
Child,     90. 
Chloasma,     30. 

Chloroform,    P^smarch's    inhaler,    66, 
147. 

Obstetrical     degree.     66. 

Surgical   degree,    66. 
Chorion,    18,    19,    21. 
Circulation,    fetal,    91.    92. 

Utero-placental,    22. 
Circumcision,    118. 
Cleft  palate,   316,   117. 
Clitoris,    8. 

Frenum    of,    8. 
Clothing  in  pregnancv.   35,   187. 

Baby's,    60. 

Of  patient   at   deliverv,    54. 
Club     feet,     117. 
Coccyx,    1,   2,    5. 

Fracture    of,    2. 
Colic  in  newborn.   119. 

"Three    months',"    104. 
Colon   bacillus   in    cystitis,    177. 

In   pyelitis,    177. 

Irrigation.    142. 
Colostrum,   28. 

Reappearance   of,   131. 
ro'neurynter.    160. 


Complications,    obstetric,    163. 

Of  labor,   169. 

Of  pregnancy,   163. 

Of     puerperium,     173. 
Conception,    17. 

During  nursing,  131. 
Conjugate  diameter,  3. 
Constipation,    177. 

In   newborn,    98. 
Contagious     diseases     and     confine- 
ment,    183. 
Cooke,    102. 

Cooke's   breast   binder,    74. 
Cord,   23. 

Dressing,   52,   94. 

Hemorrhage   from.    23. 

Implantation   of.    23. 

Tying    of,     23,    68. 
Coronal  suture,   91. 
Corpus    luteum,    17. 
Corsets,    186. 

In  pregnancy,   36. 
Couveuse,    112. 

Cow's  milk  as  milk-maker,   77. 
Cranial    bone,    depression    of,     126, 

127. 
Craniotomy,    143,    155. 
Cravings  in  pregnancy,   30,   34. 
Cream  line  on  certified  milk,   133. 

Dipper,    132. 
Crede  method  deliverv  of  placenta, 
70. 

Solution,    52. 

Treatment   of   eyes,    92. 
Crib     or    cradle,    i03. 
Cross-bed.     144. 
Cry    of  baby,    104. 
Cul-de-sac  of  Douglas,   12,   13,   15. 
Cushion,    obstetrical,    147. 
Cyanosis   in   newborn,    121. 
Cystitis,     176. 

D 

Davidson    syringe,    161. 
Decidua    reflexa,    19. 

Serotina.    19,    22. 

Vera.    19. 
Decidual    membranes,    19. 
Deciduous   teeth.   111. 
Delivery  room,   52. 
Deming  milk   modifier.    134. 
Dewey's    mixture,    120. 
Diameter,     antero-posterior,     4. 

Conjugate.    3,    7. 

Oblique,    4. 

Transverse,    4. 
Diazo  reaction.   183. 
Diet   in   pregnancy,    34,    189. 

Tn    puerperium,    79. 
Dietary.    79. 

Digestive   system   in  pregnancy,   29. 
Dipper,   Chapin's  cream,   132. 


Index 


241 


Douche,    55,    84,    158. 
Pan,    83. 

Point,    intra-uterine,    85. 
Vaginal,   85. 

Douglas'    cul-cle-sac,    12. 
Dressings,    sterilization    of,    199. 
Ductus   arteriosus,    92. 

Venosus,     91. 
Duration   of  pregnancy,    32. 
Dystocia,    5. 


Eclampsia,     cause     of,     165. 

In  puerperium,   184. 

Prognosis,    166. 

Symptoms    of,    165. 

Treatment   of,    166. 
Ectoderm,    18. 
Eczema  in  newborn,  99. 
Edema   of   feet   and  ankles   in  preg- 
nancy, 39. 
Elliott's   forceps,    151. 
Embryo.    19. 
Embryology,     19. 
Enema,  15. 

Before   delivery,    54. 

In  newborn,   98. 

Nutrient,  141. 
Enteroclysis,    157. 

In   sepsis,    175. 
Entoderm,     18. 
Erb's   paralysis,    127. 
Ergot,    172. 

Erysipelas    in    puerperium,    184. 
Esmarch's    chloroform    inhaler,    66, 

147. 
Eustachian  valve,    91. 
Eutocia,    5. 
Examination    in   labor.    55,    56. 

Vaginal,    59. 
Exanthemata    in    puerperium.    183. 
Exercise  in  pregnancy.    35,   187. 
Extra-uterine    pregnancy,    168. 
Eves,  injury  to  bv  forceps.   126. 

Toilet   of.   92. 


Face     presentation.     47. 

Facial    parah'sis,    126. 

Fallopian    tubes.    13,    16,    17,    19. 

Fecundation.    17. 

Feeding,    artificial,    131. 

Quantity  of,   135. 

Rectal,    141. 

Schedule   of.   136. 
Feet,     club,     117. 
Fertilization,    17. 
Fetal   circulation,   91,   93. 

Heart,    25. 

Skull,     90. 


Fetus,    18,    19. 

Attitude   of,   47. 

Measurement    of,    18. 

Weight,    18. 
Fever,   inanition,   108. 

Milk,    180. 
Fingers,    supernumerary,    116. 

Webbed,    116. 
Fistula,    10. 

Recto-vaginal,    10. 

Vesico-vaginal,    10. 
Flannels,     washing,     200. 
Fontanelles,    91. 
Foods,    artificial,    139. 

Liebig,    140. 

Malted,    140. 

Milk,     140. 
Foramen    ovale,    92. 

Patent,     121. 
Forceps,    143,    148. 

Axis     traction,     148. 

Elliott,    151. 

High,    126,    148. 

Indications  for,   149. 

Low,    149. 

McLain,     151. 

Median,    149. 

Operation,    126,    150,    157. 

Volsellum,    161. 
Foreskin,   in  newborn,    118. 
Formula?,    milk,     132. 
Fountain    syringe,    85. 
Frenum  linguae,  clipping  of,  125. 
Frontal   suture,    91. 
Fundus,  holding  after  labor,   73. 

In  puerperium,  86. 
Funis,     23. 

Band    applicator,    67. 

G 

G-alactagogues,    77. 
Gavage,    126,    128,   140. 

In    tetanus,    128. 
Generative  organs,   7. 

External,    7. 

Internal,    7. 
Genito-urinary      system      in      preg- 
nancy,   26. 
Glands,    compound    racemose,    9. 

Of  Bartholin,    8. 

Of   Montgomery,    10,    27. 
Glossary,    205. 

Gloves,  sterilization  of  rubber,   198. 
Graafian   follicle,    14,    16. 
Grip    in   puerperium,    183. 


H 


Hammock    scales     (Cooke),     102. 
Hands,   preparation  of  for  delivery, 
58. 
Sterilization  of,   198. 


242 


Index 


Hare-lip,    116,    117. 
Head,    infant's,    90. 

Presentation,    47. 
Heart,     25. 

Fetal,  25. 

Frequency    of,    26. 
Listening   for,   25. 
Heartburn   in   pregnancy,    29. 
Heat,    effect    of    on   milk,    139. 
Hematoma    of    muscle,     126. 
Hemorrhages  in  pregnancy,  168. 

Of   newborn,    122. 

Postpartum,  72,  171. 
Nursing  after,   172. 
Symptoms,    171. 
Treatment,    172. 

Uterine,   54. 
Hemorrhoids,     15. 
Hernia    cerebri,     116. 

Umbilical,    123. 
High    forceps    injuries    to    newborn, 

126. 
Hirst,    184. 

Holmes,   Oliver  Wendell,   173. 
Holt,  L.  Emmet,  108. 
Ilydramnios.     21. 

Wnd   eclampsia.    166. 
Hydrocephalus,    116. 
Hygeia  nursing  bottle,  136. 
Hymen,    8. 

Varieties    of,    9. 
Hyperemesis    gravidarum,    163. 
Hypodermoclysis,    159. 

Tn   sepsis,    175. 

Hypogastric    arteries,    92. 


Ice-bag    in    sepsis,    174. 

Ilio-pectineal  line,   4. 

Ilium,    1. 

Impregnation,  12,  17. 

Inanition   fever,    108. 

Incubator,  112. 

Infancy,     abnormal     conditions     in 

116. 
Infant    feeding,    129. 

Bulb    syringe,    121. 
Infection,   puerperal,    173,   174. 
Influenza    in    puerperium,     183. 
Injection,   vaginal,   85. 

Intrauterine.      85. 
Injuries  to  newborn,  126. 
Innominate     bone,      1. 
Instruments      needed      for      forceps 
operation,    149. 

Preparation   of   for   forceps    oper- 
ation,    146. 

Sterilization    of,     199. 

Table   for,    149. 
Intertrigo,    98,    120. 
Involution.   88. 
Ischium,    1. 


Jaundice  in  newborn,   119. 

K 

Kelley,    S.   W.,    114. 

Kelly   pad,    144. 

Kidneys  in  pregnancv,  32,   188. 

Care  of,   39. 
Klebs-Loeffler   bacillus.    139. 


Labia   majora,    7. 

Minora,    7,    8. 
Labo^,   44. 

Complications    of,    169. 

Conduct    of,    65. 
First  stage.   65. 
Second  stage,  65. 
Third    stage,    69. 

Dry,   21,   46. 

Duration  of,   46. 

Indications    for    inducing    prema- 
ture,    160. 

Induction      of      premature.      143. 
160. 

Mechanism  of,    5. 

Nurse's    duties    in,    48. 

Pains.     192. 

Preparation   for,    48,    192. 

Preparation   of   bed   for,    192. 

Preparation  of  patient  for,   192. 

Stages     of,     45. 

Supplies    for,    51. 

Third    stage,    69. 
Laboratory   adapted   milk,   132. 
Laborde    method    of    artificial    res- 
piration,    108. 
Lactation,   duration    of,    131. 
Lambdoid    suture,    90. 
Layette,   60. 
I  eg    holders.    145,    146. 
Ligaments    of    uterus,    14. 
Linaj   albicantes,   30. 
Line,   ilio-pectineal,   4. 
Liquor   amnii,    21. 
Lithotomy    position,    161. 
L.    M.    P.,    47. 
L.  O.  A.,   47. 
Lochia   alba,   20. 

Omenta.    19. 

Rubra.    19. 
Lockjaw,    1-57. 
L.   S.  A..   47. 
Lying-in,    duration    of,    88. 

Room,     45.     52.     190. 
Lysol  solution,  197,  201. 

M 

Mabbott.    J.    Milton.    43. 
McLain    forceps,    151. 
Malaria  in  puerperium,   181. 


Index 


243 


Malnutrition    and    teeth,    111. 
Mania,   puerperal,   184. 
Mastitis,     178,     182. 

Chart   of,    179. 
Maternal    impressions,    41. 

Nursing,     129,     188. 

Contraindications    to,    129. 
Measuring  pelvis,    56,    57. 
Meatus,    8,    14. 
Mechanism   of  labor,   5. 
Meconium,    28,    97. 
Melena,    123. 

Membranes,  rupture   of,   46. 
Menopause,      16. 
Menses,   cessation   of,   26. 

Reappearance  of,   131. 
Menstruation,    16. 

During   lactation,    88,    131. 

In   infant,    122. 
Mental  condition  in  pregnancy,  40. 
Mentum,      47. 
Mercurv,     bichloride     of,      solution, 

197. 
Mesoderm,   18. 

Midwifery,    aseptic,    173,    198. 
Milk,    adapted,    132. 

Breast,    130. 

Examination  of,  130. 

Certified,    133,    135. 

Cow's,    135. 

Effect   of  heat   on,    139. 

Fever,    180. 

Laboratory,     132. 

Walker-Gordon.    132. 
Neill  Roach,  132. 

Modification  of,   132. 

Modified,    132. 

Modifier,    Deming,    134. 

Pasteurization    of.    138. 
Wholesale,     139. 

Percentage   of   cow's,    132. 

Percentage  of  human,  132. 

Sterilization   of,    138. 

Teeth,    111. 
Mons    veneris,    7. 

Montgomery,  glands  of,  10,  27,  178. 
Morning  sickness,  29,   163. 
Morula,     17. 

Mothers,    advice   to   expectant,    186. 
Mouth  in  newborn,   109. 
Multipara,    45. 
Multiple   pregnancv   and   eclampsia, 

166. 
Murphy,    142. 

N 

Nail-brush,  sterilization  of.   199. 
Napkins,    care    of.    63. 

Washing   of,    99. 
Nasal     syringe.     125. 
Nausea  and  vomiting  of  pregnancy, 

163. 
Navel,     91. 


Newborn,    abnormal    conditions    in, 
116. 

Bowels    in,    97. 

Colic     in,      119. 

Constipation   in,    98. 

Cry    of,    104. 

Cyanosis    of,    121. 

Eczema   in,    99. 

Enema    in,    98. 

Hemorrhages  in,   122. 

Imperforate  anus  in,  99. 

Injuries    to,     126. 

Intertrigo  in,  98,  120. 

Mouth    of,    109. 

Pulse    of,    108. 

Respiration   of,    104. 
Artificial,     105. 

Sepsis,   125. 

Sleep    of,    103. 

Sprue,     109. 

Snuffles   in,    117. 

Starvation    temperature    in.    108, 
109. 

Stomach    of,    113. 

Stools   in,    120. 

Syphilis    in,    117. 

Teeth    in,     111. 

Temperature   of,    108. 

Thrush,  109. 

Uric  acid  sand  in,   99. 

Urine    of,    99. 

Weighing    of,    100. 
Nipples,    73. 

Care    of,    42.    74. 

Forms  of,  42. 

Rubber,    136. 
Care    of,    136. 

Shield,  75. 
Nucleolus,  24. 
Nucleus,    24. 

Nurse,     duties     of,     in     puerperium. 
72. 

Preparation    of,    for   labor,    48. 

Qualifications    of    obstetrical,    49. 

Uniform   of,   50. 
Nursery,    64. 
Nursing,    maternal,    129,    188. 

Contraindications    to,    129. 

Period,    duration    of,    131. 
In  hemorrhage,    172. 
In     sepsis,     174. 
Nympbaa,    8. 


Obstetrical   complications,    163. 

Cushion,    147] 

Outfit,   51,   191. 
Occiput.   47. 
Oligohydramnios,    21. 
Operative    obstetrics.    143. 
Ophthalmia      neonatorum,      preven- 
tion of,   92. 

Treatment  of.  94. 


24-f 


Index 


Osmosis,   22. 

Ossa  innominata,   1. 

Outfit,   obstetrical,   51,   191, 

Outlet  of  pelvis,   4. 

Ova,   14,   17. 

Ovaries,    12,    14. 

Ovulation,    16. 


Pains,   labor,   44,    192. 

False,    45. 
Palate,    cleft,    116,    117. 
Pasteurization     of    milk,     138. 
Patient,      preparation      of,      for     de- 
livery,   54,    19  2. 

For    operation,    144. 
Pattern    of   breast   binder,    74. 
Pectineal   eminence,    4. 
Pelvimeter,   5. 
Pelvis,   bony,    1. 

Deformity    of,    3,    7. 

Differences  between  male  and  fe- 
male,  6. 

Dvnamic,    4. 

False.    4. 

Measuring,    56. 

Planes   of,   6. 

Quadrants    of,    47. 

Static,   4. 

True,   4. 
Perforator,    155. 
Perineorrhaphy.   85,    149,    155,   158. 

After-care,    156. 

Primary,    84,    155. 

Sutures,  removal  of,   155. 
Perineum,    9. 

Laceration  of,  9. 

Primary   repair    of,    70. 
Peritoneum,    15. 
Pernicious    vomiting.    29,    163. 
Pfau   obstetrical   outfit.   51.    191. 
Phlegmasia    alba   dolens,    175. 
Physical    signs    in    atelectasis,    124. 
Pigment   of   skin   in   pregnancy,    30. 
Pitchers,    sterilization    of,    200. 
Placenta.    18,    21,    22. 

Circulation  in,   22. 

Crede  method  of  delivery   of,    70. 

Previa,     160,     168. 
Pneumonia   in   puerperium.    184. 
Position.    47. 

Dorsal,    46. 

Lithotomy,    46.    161. 

Sims',   46,    161. 
Pre-eclamptic  stage,   165. 
Pregnancy,       abdominal       supporter 
in,   187. 

Bathing    in.    189. 

Blood    in,    31. 

Care    of,    34. 

Clothing   in,    35.    187. 

Complications    of.    163. 

Corsets  in,  186. 


Pregnancy — Continued. 

Dentistry  in,  35. 

Diet  in,   34,   189. 

Duration  of,  32,  44. 

Exercise   in,    35,    187- 

Extra-uterine,    168. 

False,    28. 

Hemorrhages   in,    168. 

Kidneys  in,  32. 

Multiple,    24. 

Eclampsia   in,    166. 

Xausea  and  vomiting  of.  29,  163. 

Neuralgias  in,    32. 

Nursing,     190. 

Respiration   in,    31. 

Signs   of,    25. 
Positive.     25. 
Presumptive.    20. 

Teeth  in.   32,   35,   189. 

Tubal,    168. 

Twin,   24. 

Unusual   symptoms   in,   188. 
Premature   infants,    112. 

Labor,   induction  of,   143. 
Presentation.  46. 

Breech,   153,  170. 

Face.    47. 

Shoulder,    47. 

Transverse,   47. 

Vertex,    47. 
Primipara,   45. 
Progress    of   child,    101. 
Promontory    of   sacrum.    3. 
Pruritus,    i67. 
Pseudocvesis,    28. 
Puberty,  16. 
Pubic  bone,    1. 
Pubiotomy,    153. 
Pubis,  symphisis.   1. 
Puerperal   infection,    173. 

Mania,    184. 
Puerperium.   beginning   of.    71,   72. 

Bladder    in,    81. 

Bowels    in,    79. 

Complications    of.    173. 

Diet    in,    77. 

Duration   of,    88. 

Nurse's    duties    in.    72. 

Eclampsia    in.    184. 

Erysipelas.    184. 

Exanthemata    in,    134. 

Grip   or   influenza   in,    183. 

Infection    in,    173. 

Intestinal      autointoxication      in. 
181. 

Malaria   in.   182. 

Mastitis,    182. 

Nurse's  duties  in.   72. 

Pneumonia    in,    184. 

Rest    in,     86. 

Scarlet  fever  in,  183. 

Temperature    in,    179. 

Tuberculosis   in,    183. 
Pulse  of  newborn.   108. 


Index 


245 


Pump,    breast,    78. 
Pyelitis,   177. 

a 

Quadruplets,  24. 

Quantity  at  a  feeding,   135. 

Quickening,     28. 

R 

Rectal  feeding,  141. 
Rectum,    14,    15. 
Reproductive   organs,    16. 
Respiration    in    newborn,    104. 

Artificial,   105. 

In  pregnancy,  31. 
Rest  after  delivery,   86. 

In  pregnancy,  40. 
Rickets  and  teeth,  111. 
Roach,    Neill,    laboratory,    132. 
Room  for  delivery,   52. 

Preparation     of,     for    operations, 
143. 
Rubber   nipples,    137. 


Saccharomyces   albicans,    110. 
Sacro-coccygeal  joint.  2. 

Ankylosis,   2. 
Sacro-iliac  synchondrosis.   1. 
Sacrum,   1,   47. 

Promontory,    3. 
Sagittal  suture,  91. 
Saline    solution,    197. 
Salivation,   30. 
Sand,  uric  acid,  99. 
Sapremia,   173. 
Scales,    100,    101,    102. 
Scarlet  fever  in  puerperium,  183. 
Schultze    method    of    artificial    res- 
piration,  105,   106.   107. 
Secundines,   birth   of,   45. 
Segmentation.  17. 
Sepsis  in  newborn,   125. 

Nursing  in,  174. 

Puerperal,   174. 

Symptoms,   174. 

Treatment,   174. 
Septic  infection  through  umbilicus, 

95. 
Settling,   44. 
Shield  nipple,    75. 
Shoulder   presentation,    47. 
Show,  45. 

Sickness,   morning,    29,    163. 
Sigmoid   flexure,    14. 

Of  newborn,   99. 
Sims'   position,   46,   161. 

In    rectal    feeding,    141. 
Skin  in  pregnancy,   30. 

Laceration  bv  high  forceps.   126. 
Skull,   fetal,    90. 
Sleen  of  newborn,  103. 
Snuffles  in  newborn,   117. 


Solutions,    197. 

Bichloride  of  mercury,  59,  197. 

Boracic  acid,   197. 

Carbolic   acid,    59,    198. 

Creolin,    59. 

For   hands,    59. 

L\sol,    197. 

Saline,    197. 
Somatose,   77. 
Sen  He,   23 
Speculum,    bivalve,    148,     161. 

Sims',   161. 

Vaginal,   148. 
Spermatozoon,    17. 
Sphincter  of  rectum.  9. 

Tear   of,    9. 
Spina  bifida,   116. 
Spine,    108. 
Sprue,    109. 

Starvation      temperature      in      new- 
born,  108. 

Chart    of,    109. 
Static    pelvis.    4. 
Steelyards,    100. 
Sterile   water,    197. 
Sterilization,    138. 

Of   dressings.    198. 

Of  gloves,    198. 

Of   hands,    59,    198. 

Of  instruments,   198. 

Of    nail-brush,     198. 

Of  pitchers,   200. 
Sterilizer,    hygeia    milk,    138. 
Stomach,  tracing   of   infant's,   113. 
Stools    in  newborn,    120. 
Strait,     4. 

Inferior,     4. 

Superior,    4. 
Stria?,     30. 

Of  breasts,   28. 
Strippings  of  breast  milk,   130. 
Sudamina  in  newborn,  97,  119. 
Supplies  for  labor.  51. 
Supporter,   abdominal.    37. 

In    pregnancy,    187. 
Suture,    coronal.    91. 

Frontal,    91. 

Lambdoid,    90. 

Sagittal,    91. 
Sychondrosis.   sacro-iliac,   1. 
Sylvester   method   artificial   respira- 
tion,  105. 
Symphysiotomy,    153. 
Symphysis  pubis.   1,   3.   7. 
Svphilis  in  newborn.  117. 
Syringe,  infant's  bulb,  121. 

Fountain,    85. 


Tampon,  uterine,   157. 

Vaginal,    157. 
Teeth  in  newborn.   110. 

In   pregnancy.    32.    189. 


246 


Index 


Teeth  in  newborn— Continued. 

Deciduous,    111. 

Permanent,   111. 
Temperature  in  puerperium,   179. 

Of  newborn,  108. 

Starvation,  108,  109. 
Tetanus,   127. 

Diagnosis    of,    128. 

Prognosis    of,    128. 

Prophylaxis,    128. 

Symptoms,    128. 

Treatment  of,   128. 
Thrush,    109. 

Thyroid  gland  in  pregnancy,  32. 
Tongue-tie,  116. 
Toxemia  of  pregnancy,   163. 
Transfusion,    157. 
Transverse  presentation,   47. 
Triplets,   24. 
Tubal  pregnancy.   168. 
Tuberculosis   in  pregnancy,    183. 
Tubes,   Fallopian.   13,   16,   17,   19. 
Tuley's  obstetrical  outfit,   51. 
Twin  pregnancy,*  24. 
Typhoid  fever  in  puerperium,   183. 


Umbilical  cord,  treatment  of,   94. 

Hernia,     123. 

Vein,   91. 
Umbilicus,  95. 

In  pregnancy,   33. 
Uniform  of  obstetrical  nurse,  50. 
Urethra,    8,    14. 
Uric  acid  sand,  99. 
Urine  of  newborn,  99. 
Uterine  tampon,   157. 

Pains,    44. 
Uterus,   14. 

Holding   fundus   of,    73. 

Ligaments  of,  14. 

Settling  of,   44. 

V 

Vagina,    10. 

Color  of,  in  pregnancy,  26. 
Examination  of,  in  labor,  55. 
Orifice   of,    8. 


Vaginal  Csesarean  section,   143. 

Injections,    85. 

Tampon,    157. 
Valve,  Eustachian,  91. 
Varicose  veins,  36,  167. 
Vegetations   in  umbilicus,   95. 
Veins,  varicose,  167. 
Velamentous  insertion  cord,  23. 
Vernix  caseosa,   18. 
Version,   126,    143,    152. 

Dangers     of,     152. 

Podalic,    152. 
Vertex   presentation,   47. 
Vesicle,  blastodermic,  17. 
Vestibule,    8. 
Viable,    18,    112. 
Villi,    22. 

Volsellum  forceps,  162. 
Vomiting  of  pregnancy,  29,   163. 

Pernicious,    29,    163. 

Of  newborn,    120. 
Vulva,    7.    84. 

Protection    of,    70. 

Pruritus   of,   167. 

Varicose    veins    of,    36, 


W 

Walker-Gordon  laboratory,    132. 
Water  for  infants,   138. 

Sterile,    197. 
Webbed  fingers,  116. 
Weed  in  breast,  76. 
Weighing   newborn,    100. 
Wet  nurse,   131. 
Wharton's   jelly,    23,    122. 

Drying   of,    69. 
Widal  test,  183. 
Winckel,    184. 


Yolk,   17. 


Obstetrical  Nursing 

REVISED      AND       ENLARGED 

By  HENRY  EN  OS   TULEY,  A.  *B.,  M.  D. 

AN      EXHAUSTIVE     WORK     ON     OBSTETRICAL     NURSING 
ADAPTED  TO    INFIRMARIES,  COLLEGES,  AND    THE    HOME 

r^HE  first  edition  of  this  book  being  entirely  exhausted,  en- 
■*-  abled  the  author  to  completely  re-write,  revise,  and  amplify 
the  text. 

The  need  of  a  book  of  this  kind  for  the  undergraduate  nurse 
to  aid  her  in  a  full  understanding  of  the  class  work  in  obstetrics 
is  obvious.  The  graduate  nurse  will  find  it  a  great  help  in  re- 
freshing her  mind  upon  many  points. 

Only  so  much  has  been  included  in  the  book  as  to  enable  the 
nurse  to  intelligently  care  for  these  cases,  and  not  merely  look 
upon  it  as  routine  or  machine-like  work.  However,  no  attempt 
has  been  made  to  overtrain  the  nurse,  the  object  being  to  so 
aid  in  her  training  that  she  will  make  an  able  assistant  to  the 
obstetrician. 

The  whole  subject  has  been  systematically  covered;  the 
anatomy  of  the  female,  physiology  of  the  sex,  embryology, 
pregnancy,  labor,  the  puerperium  and  the  child,  are  carefully 
discussed  in  detail. 

A  feature  which  will  be  appreciated  is  the  very  complete 
Glossary  of  obstetrical  terms  which  has  been  included.  Obstet- 
rical terms  are  for  the  most  part  very  difficult  to  remember, 
and  including  this  list  adds  greatly  to  the  value  of  the  work. 

There  are  246  pages  of  text  matter  in  the  book,  together 
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